Provider Demographics
NPI:1558351783
Name:KALIDA MEDICAL ARTS, INC.
Entity Type:Organization
Organization Name:KALIDA MEDICAL ARTS, INC.
Other - Org Name:KIDD & HORSTMAN MD'S INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-532-3958
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:109 SOUTH BROAD ST
Mailing Address - City:KALIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45853-0417
Mailing Address - Country:US
Mailing Address - Phone:419-532-3958
Mailing Address - Fax:419-532-2326
Practice Address - Street 1:109 S BROAD ST
Practice Address - Street 2:
Practice Address - City:KALIDA
Practice Address - State:OH
Practice Address - Zip Code:45853
Practice Address - Country:US
Practice Address - Phone:419-532-3958
Practice Address - Fax:419-532-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH049354207Q00000X
OH35075209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000185580OtherANTHEM
289583671001OtherMEDICAL MUTUAL
293569311002OtherMEDICAL MUTUAL
OH2196752Medicaid
CA3755OtherRAILROAD MEDICARE
CH3755OtherRAILROAD MEDICARE
000000025708OtherANTHEM
OH0563322Medicaid
H21670Medicare UPIN
CH3755OtherRAILROAD MEDICARE
OH0563322Medicaid