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NPI Code Detail

MEDICARE: MID AMERICAN IMAGING, INC.

MEDICARE: MID AMERICAN IMAGING, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0208XMobile Radiology Clinic/Center02220180040OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000166606OTHEROHANTHEM BCBS OF OHIO
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3366270200OTHEROHACS/US DEPT OF LABOR
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
523753OTHEROHMEDFOCUS RADIOLOGY NETWOR
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174563670
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID AMERICAN IMAGING, INC.
Provider Business Mailing Address
First Line : 100 BAYVIEW CIRCLE
Second Line : SUITE 400
City : NEWPORT BEACH
State : CA
Zip : 92660-2984
Country : US
Telephone Number : 800-544-3215
Fax Number :
Provider Business Practice Location Address
First Line : 659 BOULEVARD ST
Second Line :
City : DOVER
State : OH
Zip : 44622-2026
Country : US
Telephone Number : 330-343-3311
Fax Number :
Authorized Official
Title or Position : SVP CORPORATE FINANCE
Name : NICHOLAS A. POAN
Credential :
Telephone Number : 949-242-5321
Provider Enumeration Date : 06/07/2006
Last Update Date : 12/08/2008

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Directions to “MID AMERICAN IMAGING, INC. ” Practice Location

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