MEDICARE: ID MED INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306986146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ID MED INC.

Provider Business Mailing Address
First Line	:	2970 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2651
Country	:	US
Telephone Number	:	614-279-0808
Fax Number	:	614-279-6111

Provider Business Practice Location Address
First Line	:	2970 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2651
Country	:	US
Telephone Number	:	614-279-0808
Fax Number	:	614-279-6111

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK T HERBERT
Credential	:	MD
Telephone Number	:	614-279-0808

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	11/11/2009

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