MEDICARE: MID-OHIO HEART CLINIC, 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	207RC0000X	Cardiovascular 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	:	1598756314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-OHIO HEART CLINIC, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1257
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44901-1257
Country	:	US
Telephone Number	:	419-524-8151
Fax Number	:	419-524-2376

Provider Business Practice Location Address
First Line	:	680 PARK AVE W
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3706
Country	:	US
Telephone Number	:	419-524-8151
Fax Number	:	419-524-2376

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	ANN M. SCOTT
Credential	:	CPC, CCS-P
Telephone Number	:	419-524-8151

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	04/20/2008

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