Provider Demographics
NPI:1407837826
Name:MIDLOTHIAN MEDICAL CENTER INC
Entity Type:Organization
Organization Name:MIDLOTHIAN MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-788-8791
Mailing Address - Street 1:2010 E MIDLOTHIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-2951
Mailing Address - Country:US
Mailing Address - Phone:330-788-8791
Mailing Address - Fax:330-788-4033
Practice Address - Street 1:2010 E MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2951
Practice Address - Country:US
Practice Address - Phone:330-788-8791
Practice Address - Fax:330-788-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0282171Medicaid
OH0282171Medicaid
OH=========00OtherWORKERS COMPENSATION