1386691780 NPI number — MID-OHIO EMERGENCY SERVICES, LLC

Table of content: (NPI 1386691780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386691780 NPI number — MID-OHIO EMERGENCY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-OHIO EMERGENCY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386691780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1643 NW 136TH AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-424-3672
Provider Business Mailing Address Fax Number:
954-377-3042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 S GRANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43215-4701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-566-9000
Provider Business Practice Location Address Fax Number:
614-566-8072
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DECKER
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-424-3672

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000066092 . This is a "ANTHEM OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: CI6323 . This is a "MEDICARE TRAVELERS RR - G" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 020304100 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2099116 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 365758501 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 020208900 . This is a "FEDERAL BLACK LUNG PROGRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2099107 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 365758500 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 012462300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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