Healthcare Provider Details

I. General information

NPI: 1235353103
Provider Name (Legal Business Name): MID-OHIO VALLEY MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WASHINGTON BLVD SUITE 1
BELPRE OH
45714-2465
US

IV. Provider business mailing address

800 GRAND CENTRAL MALL SUITE 4
VIENNA WV
26105-4100
US

V. Phone/Fax

Practice location:
  • Phone: 740-423-5055
  • Fax: 740-423-5058
Mailing address:
  • Phone: 304-485-4439
  • Fax: 304-485-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1514286
License Number StateOH

VIII. Authorized Official

Name: MRS. LISA G HAYS
Title or Position: OFFICE COORDINATOR
Credential:
Phone: 304-485-4439