=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306878863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDCENTRAL PROFESSIONAL ASSOCIATION INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 11/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 308 GLESSNER AVE
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44903-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-526-8768
-----------------------------------------------------
Fax | 419-522-4697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 308 GLESSNER AVE
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44903-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-526-8768
-----------------------------------------------------
Fax | 419-522-4697
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. MICHAEL F. BARRON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-526-8768
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 34003540P
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 35066820
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 35030853F
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------