Basic Information
Provider Information
NPI: 1477590305
EntityType: 2
ReplacementNPI:  
OrganizationName: MID-WEST VASCULAR INSTITUTE INC
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Mailing Information
Address1: 1003 BELLEFONTAINE AVE
Address2: SUITE 150
City: LIMA
State: OH
PostalCode: 458042800
CountryCode: US
TelephoneNumber: 4199988207
FaxNumber: 4199988208
Practice Location
Address1: 1003 BELLEFONTAINE AVE
Address2: SUITE 150
City: LIMA
State: OH
PostalCode: 458042800
CountryCode: US
TelephoneNumber: 4199988207
FaxNumber: 4199988208
Other Information
ProviderEnumerationDate: 05/31/2006
LastUpdateDate: 06/21/2008
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: MAGEE
AuthorizedOfficialFirstName: RONALD
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 4199988207
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0129X84224OHY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery

ID Information
IDTypeStateIssuerDescription
DD549501OHRAILROAD MEDICAREOTHER


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