Mid-Ohio Medical Associates, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MID-OHIO MEDICAL ASSOCIATES, INC.

Practice address

621 Broad St SW
Ste 1E
Pataskala, OH 43062-8118

Phone

(740) 927-5044

NPI assigned

Mar 28, 2007

Last updated

Sep 19, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bobbie J Fisher

Title

Ar Manager

Phone

(614) 322-7300

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221782400000",
    "number": "1538288089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1492 E BROAD ST",
            "address_2": "SUITE 1501",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432051546",
            "telephone_number": "614-252-2191",
            "fax_number": "614-252-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 BROAD ST SW",
            "address_2": "STE 1E",
            "city": "PATASKALA",
            "state": "OH",
            "postal_code": "430628118",
            "telephone_number": "740-927-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-OHIO MEDICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2008-09-19",
        "status": "A",
        "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"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0929857",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG4264",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2008; 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.