Provider Demographics
NPI:1912192618
Name:GREATER OHIO CARDIOLOGY,INC
Entity Type:Organization
Organization Name:GREATER OHIO CARDIOLOGY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:740-845-0000
Mailing Address - Street 1:136 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1229
Mailing Address - Country:US
Mailing Address - Phone:740-845-0000
Mailing Address - Fax:
Practice Address - Street 1:136 E HIGH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1229
Practice Address - Country:US
Practice Address - Phone:740-845-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-1554C261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2108454Medicaid
OH2108454Medicaid
OHF68831Medicare UPIN
OH0833411Medicare PIN
OH0833413Medicare PIN