Provider Demographics
NPI:1477590305
Name:MID-WEST VASCULAR INSTITUTE INC
Entity Type:Organization
Organization Name:MID-WEST VASCULAR INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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
OH842242086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD5495OtherRAILROAD MEDICARE
OH9350211Medicare PIN