Healthcare Provider Details

I. General information

NPI: 1578569588
Provider Name (Legal Business Name): LIMA MEMORIAL JOINT OPERATING COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/21/2022
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BELLEFONTAINE AVE
LIMA OH
45804-2800
US

IV. Provider business mailing address

1001 BELLEFONTAINE AVE
LIMA OH
45804-2800
US

V. Phone/Fax

Practice location:
  • Phone: 419-226-5165
  • Fax: 419-226-5128
Mailing address:
  • Phone: 419-226-5165
  • Fax: 419-226-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateOH

VII. Legacy identifiers

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

# 1
Identifier000000174124
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS
# 2
Identifier0021501
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 3
Identifier5184518
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 4
Identifier05199
Identifier TypeOTHER
Identifier State
Identifier IssuerPARAMOUNT

VIII. Authorized Official

Name: ERIC D POHJALA
Title or Position: CFO
Credential:
Phone: 419-226-5163