Provider Demographics
NPI:1073700647
Name:RUDOLPH J. VELA M.D. INC.
Entity Type:Organization
Organization Name:RUDOLPH J. VELA M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-448-0220
Mailing Address - Street 1:3101 W. U.S. RTE 224
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8305
Mailing Address - Country:US
Mailing Address - Phone:419-448-0220
Mailing Address - Fax:419-448-0461
Practice Address - Street 1:3101 W. U.S. ROUTE 224
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8305
Practice Address - Country:US
Practice Address - Phone:419-448-0220
Practice Address - Fax:419-448-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0659498Medicaid
VE059662OtherMEDICARE
A16865Medicare UPIN