Provider Demographics
NPI:1023062221
Name:MID-OHIO SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:MID-OHIO SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-228-0768
Mailing Address - Street 1:750 MOUNT CARMEL MALL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1553
Mailing Address - Country:US
Mailing Address - Phone:614-228-0768
Mailing Address - Fax:614-228-7381
Practice Address - Street 1:750 MOUNT CARMEL MALL
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1553
Practice Address - Country:US
Practice Address - Phone:614-228-0768
Practice Address - Fax:614-228-7381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0736510Medicaid
OH0736510Medicaid