Healthcare Provider Details

I. General information

NPI: 1306878863
Provider Name (Legal Business Name): MEDCENTRAL PROFESSIONAL ASSOCIATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 GLESSNER AVE
MANSFIELD OH
44903-2225
US

IV. Provider business mailing address

308 GLESSNER AVE
MANSFIELD OH
44903-2225
US

V. Phone/Fax

Practice location:
  • Phone: 419-526-8768
  • Fax: 419-522-4697
Mailing address:
  • Phone: 419-526-8768
  • Fax: 419-522-4697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35030853F
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number34003540P
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35066820
License Number StateOH

VIII. Authorized Official

Name: MR. MICHAEL F. BARRON
Title or Position: DIRECTOR
Credential:
Phone: 419-526-8768