Provider Demographics
NPI:1538288089
Name:MID-OHIO MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MID-OHIO MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-322-7300
Mailing Address - Street 1:1492 E BROAD ST
Mailing Address - Street 2:SUITE 1501
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1546
Mailing Address - Country:US
Mailing Address - Phone:614-252-2191
Mailing Address - Fax:614-252-2194
Practice Address - Street 1:621 BROAD ST SW
Practice Address - Street 2:STE 1E
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8118
Practice Address - Country:US
Practice Address - Phone:740-927-5044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDG4264OtherRAILROAD MEDICARE
OH0929857Medicaid
OH0929857Medicaid