1235353103 NPI number — MID-OHIO VALLEY MEDICAL GROUP INC.

Table of content: (NPI 1235353103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235353103 NPI number — MID-OHIO VALLEY MEDICAL GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-OHIO VALLEY MEDICAL GROUP INC.
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:
Provider Other Organization Name Type Code:
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:
1235353103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 GRAND CENTRAL MALL
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26105-4100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-485-4439
Provider Business Mailing Address Fax Number:
304-485-6489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BELPRE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45714-2465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-423-5055
Provider Business Practice Location Address Fax Number:
740-423-5058
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAYS
Authorized Official First Name:
LISA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OFFICE COORDINATOR
Authorized Official Telephone Number:
304-485-4439

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  1514286 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2751991 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810008457 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF3852 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com