Healthcare Provider Details

I. General information

NPI: 1043215627
Provider Name (Legal Business Name): MIDOHIO CARDIOLOGY AND VASCULAR CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 OLENTANGY RIVER RD STE 100
COLUMBUS OH
43214-3467
US

IV. Provider business mailing address

PO BOX 73444
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 614-262-6772
  • Fax: 614-262-7074
Mailing address:
  • Phone: 614-265-2921
  • Fax: 614-262-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35-062660
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35-055344
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35-058287
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-07581
License Number StateOH

VIII. Authorized Official

Name: MRS. PEGGY L HYLTON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 614-573-5416