Basic Information
| Provider Information | |||||||||
| NPI: | 1376509661 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID OHIO ONCOLOGY HEMATOLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 PLAZA PROPERTIES BLVD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432191530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143836000 | ||||||||
| FaxNumber: | 6143836001 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 PLAZA PROPERTIES BLVD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432191530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143836000 | ||||||||
| FaxNumber: | 6143836001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 02/27/2013 | ||||||||
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| AuthorizedOfficialLastName: | ELWOOD | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6143836000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35046723 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0606713 | 05 | OH | MEDICAID | 3676155 | 01 | NCPDP | OTHER |