NPIMap

Organization Active NPI

Lima Memorial Professional Corporation

Doing business as Indian Lake Medical Center

  • Family Medicine Physician
  • Russells Point, OH
National Provider Identifier
1558788646
Registry record updated Apr 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIMA MEMORIAL PROFESSIONAL CORPORATION
Doing business as
Indian Lake Medical Center
Lima Memorial Health System Indian Lake Medical Center
Practice address
322 E Main St
Russells Point, OH 43348-9601
Phone
(937) 842-2318
Fax
(937) 842-2414
NPI assigned
Mar 26, 2014
Last updated
Apr 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2022

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

Authorized official

Name
Jeffrey Utz
Title
Director of LMP
Phone
(419) 998-4668

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

322 E Main St
Russells Point, OH 43348-9601

Mailing address

1001 Bellefontaine Ave
Lima, OH 45804-2800
Phone (419) 998-4575

Other identifiers 2

IdentifierTypeStateIssuer
2223703MedicaidOH
1457474900OtherOHGROUP NPI

Other names 2

  • Indian Lake Medical Center Doing business as
  • Lima Memorial Health System Indian Lake Medical Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2077415LMHS Indian Lake Medical Center322 E Main St, Russells Point, OH 43348Certificate of waiverMay 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lima Memorial Professional Corporation40 organizations share this tax ID, including this one

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

Locations

322 E Main St
Russells Point, OH 43348
Phone (937) 842-2318

NPI Registry JSON

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649462400000",
    "number": "1558788646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 BELLEFONTAINE AVE",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458042800",
            "telephone_number": "419-998-4575",
            "fax_number": "419-998-4586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 E MAIN ST",
            "city": "RUSSELLS POINT",
            "state": "OH",
            "postal_code": "433489601",
            "telephone_number": "937-842-2318",
            "fax_number": "937-842-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIMA MEMORIAL PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-26",
        "last_updated": "2022-04-09",
        "certification_date": "2022-04-09",
        "status": "A",
        "authorized_official_last_name": "UTZ",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "DIRECTOR OF LMP",
        "authorized_official_telephone_number": "419-998-4668"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2223703",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1457474900",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Lake Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Indian Lake Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lima Memorial Health System Indian Lake Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Russells Point, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.