1720248891 NPI number — MID-OHIO PEDIATRICS AND ADOLESCENTS, INC.

Table of content: (NPI 1720248891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720248891 NPI number — MID-OHIO PEDIATRICS AND ADOLESCENTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-OHIO PEDIATRICS AND ADOLESCENTS, 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:
1720248891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
595 COPELAND MILL RD
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43081-8908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-899-0000
Provider Business Mailing Address Fax Number:
614-794-7597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
595 COPELAND MILL RD
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
WESTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43081-8908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-899-0000
Provider Business Practice Location Address Fax Number:
614-794-7597
Provider Enumeration Date:
06/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
614-899-0000

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0784021 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com