Provider Demographics
NPI:1205025699
Name:RHEUMATOLOGY CLINIC OF LIMA, LLC
Entity Type:Organization
Organization Name:RHEUMATOLOGY CLINIC OF LIMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOBAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-222-3758
Mailing Address - Street 1:750 W HIGH ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2969
Mailing Address - Country:US
Mailing Address - Phone:419-222-3758
Mailing Address - Fax:419-222-2023
Practice Address - Street 1:750 W HIGH ST
Practice Address - Street 2:SUITE 260
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-2969
Practice Address - Country:US
Practice Address - Phone:419-222-3758
Practice Address - Fax:419-222-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077426P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2165615Medicaid
OH0895621Medicare PIN
OHG11367Medicare UPIN