Provider Demographics
NPI:1659794980
Name:MID AMERICA HEALTH
Entity Type:Organization
Organization Name:MID AMERICA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HYGENIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:V
Authorized Official - Last Name:CANANT
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:440-454-0746
Mailing Address - Street 1:6041 STEARNS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-4108
Mailing Address - Country:US
Mailing Address - Phone:440-454-0746
Mailing Address - Fax:
Practice Address - Street 1:6041 STEARNS RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-4108
Practice Address - Country:US
Practice Address - Phone:440-454-0746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6670251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare