MEDICARE: MIDLOTHIAN MEDICAL CENTER 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	207Q00000X	Family Medicine 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	:	1407837826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDLOTHIAN MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	2010 E MIDLOTHIAN BLVD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44502-2951
Country	:	US
Telephone Number	:	330-788-8791
Fax Number	:	330-788-4033

Provider Business Practice Location Address
First Line	:	2010 E MIDLOTHIAN BLVD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44502-2951
Country	:	US
Telephone Number	:	330-788-8791
Fax Number	:	330-788-4033

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	DR. RUSSELL A MORRISON
Credential	:
Telephone Number	:	330-788-8791

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	04/20/2008

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