Provider Demographics
NPI:1073553582
Name:MID AMERICAN IMAGING, INC.
Entity Type:Organization
Organization Name:MID AMERICAN IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGMORE GRUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-544-3215
Mailing Address - Street 1:100 BAYVIEW CIRCLE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2984
Mailing Address - Country:US
Mailing Address - Phone:800-544-3215
Mailing Address - Fax:
Practice Address - Street 1:1400 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2440
Practice Address - Country:US
Practice Address - Phone:419-783-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02220180040261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH20043OtherMED FOCUS RADIOLOGY NETWO
OH000000268775OtherANTHEM BC/BS OF OHIO
OH104395OtherKAISER
OH2284184Medicaid
OH26308OtherMEDFOCUS RADIOLOGY NETWOR
OH731337OtherBUCKEYE COMM HEALTH PLAN
OH23752OtherMED FOCUS RADIOLOGY NETWO
OH366270200OtherACS/US DEPT OF LABOR
OH000000166606OtherANTHEM BC/BS OF OHIO
OH2154823Medicaid
OH26308OtherMEDFOCUS RADIOLOGY NETWOR
OH=========076OtherMEDICAL MUTUAL OF OHIO
OH000000166606OtherANTHEM BC/BS OF OHIO
OH=========001OtherHEALTH NET FEDERAL/TRICAR
OH366270200OtherACS/US DEPT OF LABOR
OH=========018OtherHEALTH NET FEDERAL/TRICAR
OHID00803Medicare ID - Type Unspecified
OH000000268775OtherANTHEM BC/BS OF OHIO
OH=========018OtherHEALTH NET FEDERAL/TRICAR
OH20043OtherMED FOCUS RADIOLOGY NETWO