Provider Demographics
NPI:1124220579
Name:RS MEDICAL GROUP
Entity Type:Organization
Organization Name:RS MEDICAL GROUP
Other - Org Name:ELMORE MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAGOTHAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-862-2916
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:ELMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43416-0067
Mailing Address - Country:US
Mailing Address - Phone:419-862-2916
Mailing Address - Fax:419-862-1701
Practice Address - Street 1:3105 SOUTH STATE ROUTE 51
Practice Address - Street 2:
Practice Address - City:ELMORE
Practice Address - State:OH
Practice Address - Zip Code:43416-0067
Practice Address - Country:US
Practice Address - Phone:419-862-2916
Practice Address - Fax:419-862-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037046207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0181646Medicaid
OH0290288Medicaid
OH0152338Medicaid
OH7351404Medicaid
FL9128061Medicare PIN