Healthcare Provider Details

I. General information

NPI: 1306986146
Provider Name (Legal Business Name): ID MED INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 W BROAD ST
COLUMBUS OH
43204-2651
US

IV. Provider business mailing address

2970 W BROAD ST
COLUMBUS OH
43204-2651
US

V. Phone/Fax

Practice location:
  • Phone: 614-279-0808
  • Fax: 614-279-6111
Mailing address:
  • Phone: 614-279-0808
  • Fax: 614-279-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK T HERBERT
Title or Position: PRESIDENT
Credential: MD
Phone: 614-279-0808