1538288089 NPI number — MID-OHIO MEDICAL ASSOCIATES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538288089 NPI number — MID-OHIO MEDICAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-OHIO MEDICAL ASSOCIATES, 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:
1538288089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1492 E BROAD ST
Provider Second Line Business Mailing Address:
SUITE 1501
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43205-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-252-2191
Provider Business Mailing Address Fax Number:
614-252-2194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 BROAD ST SW
Provider Second Line Business Practice Location Address:
STE 1E
Provider Business Practice Location Address City Name:
PATASKALA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43062-8118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-927-5044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
BOBBIE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
AR MANAGER
Authorized Official Telephone Number:
614-322-7300

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DG4264 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0929857 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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