Provider Demographics
NPI:1265489496
Name:MID-WEST SURGICAL SPECIALISTS, INC
Entity Type:Organization
Organization Name:MID-WEST SURGICAL SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:F
Authorized Official - Last Name:OAKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-998-8207
Mailing Address - Street 1:1003 BELLEFONTAINE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-8207
Mailing Address - Fax:419-998-8208
Practice Address - Street 1:1003 BELLEFONTAINE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2800
Practice Address - Country:US
Practice Address - Phone:419-998-8207
Practice Address - Fax:419-998-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0064112086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCK4410OtherRAILROAD MEDICARE
OH2411009Medicaid
OHCK4410OtherRAILROAD MEDICARE