Healthcare Provider Details

I. General information

NPI: 1124220579
Provider Name (Legal Business Name): RS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 SOUTH STATE ROUTE 51
ELMORE OH
43416-0067
US

IV. Provider business mailing address

PO BOX 67
ELMORE OH
43416-0067
US

V. Phone/Fax

Practice location:
  • Phone: 419-862-2916
  • Fax: 419-862-1701
Mailing address:
  • Phone: 419-862-2916
  • Fax: 419-862-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35037046
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISHNA M. RAGOTHAMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-862-2916