Mid Ohio Medical Management,LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35086704 Issued in OH

Legal business name

MID OHIO MEDICAL MANAGEMENT,LLC

Practice address

1755 Lancaster Ave
Reynoldsburg, OH 43068

Phone

(614) 834-7030

Fax

(614) 834-7032

NPI assigned

Jun 19, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gina Marie Nichols, MD

Title

Ceo

Phone

(614) 834-7030

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527206400000",
    "number": "1497916605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 513",
            "city": "PICKERINGTON",
            "state": "OH",
            "postal_code": "431470513",
            "telephone_number": "614-834-7030",
            "fax_number": "614-834-7032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 LANCASTER AVE",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "43068",
            "telephone_number": "614-834-7030",
            "fax_number": "614-834-7032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID OHIO MEDICAL MANAGEMENT,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-19",
        "last_updated": "2018-05-25",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "614-834-7030",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35086704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2611267",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael J. Smith, DDS, Inc.
• Michael S Tilson, DDS Ms Inc
• Michael'S Angels Transportation Services LLC
• Walter D Mick, DDS
• Mid Ohio Home Health Care, LLC
• Britannie Nichole Miller, PHARMD
• Dajuan Miller
• David Eugene Miller, PH.D.
• Katelyn C Miller, D.D.S.
• Paige Renee Miller, CDCA

• Family Medicine Physician in Reynoldsburg, OH
• Providers in Reynoldsburg, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.