Provider Demographics
NPI:1982818381
Name:MID-OHIO MEDICAL SPECIALISTS, INC.
Entity Type:Organization
Organization Name:MID-OHIO MEDICAL SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAYYAR
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:SHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-445-7209
Mailing Address - Street 1:949 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2748
Mailing Address - Country:US
Mailing Address - Phone:614-445-7209
Mailing Address - Fax:614-656-7068
Practice Address - Street 1:949 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2748
Practice Address - Country:US
Practice Address - Phone:614-445-7209
Practice Address - Fax:614-656-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067934207Q00000X
OH35047929207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170550Medicaid
OH0764098Medicaid
OHSH0783144Medicare PIN
OHG03941Medicare UPIN
OHSH0653071Medicare PIN
OHSH0653072Medicare PIN