Organization
PRIMESOURCE HEALTHCARE OF OHIO, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID FLEMING (PRESIDENT & CEO)
(847) 267-8200
Entity
Organization
Contact information
Practice address
4449 EASTON WAY, FLOOR 2, COLUMBUS, OH 43219-6093
(800) 317-0711
(877) 821-6402
Mailing address
2100 EAST LAKE COOK ROAD, SUITE 1100, BUFFALO GROVE, IL 60089-1815
(847) 267-8200
(877) 821-6402
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2719062
—
OH
Enumeration date
04/25/2008
Last updated
10/12/2011
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