Healthcare Provider Details

I. General information

NPI: 1710082516
Provider Name (Legal Business Name): MID-OHIO RADIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LONDON AVE
MARYSVILLE OH
43040-5512
US

IV. Provider business mailing address

PO BOX 714638
CINCINNATI OH
45271-4638
US

V. Phone/Fax

Practice location:
  • Phone: 800-686-4677
  • Fax:
Mailing address:
  • Phone: 614-791-1300
  • Fax: 614-791-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36083911
License Number StateOH

VIII. Authorized Official

Name: MICHAEL LAHM
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 614-791-1300