MEDICARE: MID-OHIO MEDICAL ASSOCIATES, 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
1	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DG4264	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538288089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-OHIO MEDICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	1492 E BROAD ST
Second Line	:	SUITE 1501
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1546
Country	:	US
Telephone Number	:	614-252-2191
Fax Number	:	614-252-2194

Provider Business Practice Location Address
First Line	:	621 BROAD ST SW
Second Line	:	STE 1E
City	:	PATASKALA
State	:	OH
Zip	:	43062-8118
Country	:	US
Telephone Number	:	740-927-5044
Fax Number	:

Authorized Official
Title or Position	:	AR MANAGER
Name	:	BOBBIE J FISHER
Credential	:
Telephone Number	:	614-322-7300

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	09/19/2008

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Directions to “MID-OHIO MEDICAL ASSOCIATES, INC. ” Practice Location

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