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Organization Active NPI

Mid-Ohio Valley Physical Medicine

  • Physical Medicine & Rehabilitation Physician
  • Marietta, OH
National Provider Identifier
1700098811
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
35066931L Issued in OH
Legal business name
MID-OHIO VALLEY PHYSICAL MEDICINE
Practice address
400 Matthew Street
Suite 306
Marietta, OH 45750
Phone
(740) 376-5044
Fax
(740) 374-1792
NPI assigned
May 3, 2007
Last updated
Jul 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

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

Authorized official

Name
David William Lacey, M.D.
Title
President
Phone
(740) 376-5044

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 35066931L OH Primary
Spinal Cord Injury Medicine Physician 2081P0004X 35066931L OH
Sports Medicine (Physical Medicine & Rehabilitation) Physician 2081S0010X 35066931L OH
Clinical Neurophysiology Physician 2084N0600X 35066931L OH

Addresses

Primary practice location

400 Matthew Street
Suite 306
Marietta, OH 45750

Mailing address

400 Matthew Street
Suite 306
Marietta, OH 45750
Phone (740) 376-5044

Other identifiers 2

IdentifierTypeStateIssuer
0113577000MedicaidWV
L0982950MedicaidOH

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1700098811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MATTHEW STREET",
            "address_2": "SUITE 306",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "45750",
            "telephone_number": "740-376-5044",
            "fax_number": "740-374-1792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MATTHEW STREET",
            "address_2": "SUITE 306",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "45750",
            "telephone_number": "740-376-5044",
            "fax_number": "740-374-1792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-OHIO VALLEY PHYSICAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "LACEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "740-376-5044",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OH",
            "license": "35066931L",
            "primary": true
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "OH",
            "license": "35066931L",
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "OH",
            "license": "35066931L",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "OH",
            "license": "35066931L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0113577000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L0982950",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.