Healthcare Provider Details

I. General information

NPI: 1477590305
Provider Name (Legal Business Name): MID-WEST VASCULAR INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 BELLEFONTAINE AVE SUITE 150
LIMA OH
45804-2800
US

IV. Provider business mailing address

1003 BELLEFONTAINE AVE SUITE 150
LIMA OH
45804-2800
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-8207
  • Fax: 419-998-8208
Mailing address:
  • Phone: 419-998-8207
  • Fax: 419-998-8208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number84224
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDD5495
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name: DR. RONALD R MAGEE
Title or Position: PRESIDENT
Credential: MD
Phone: 419-998-8207