MID OHIO INFECTIOUS DISEASES CLINIC LLC (NPI# 1164652822) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164652822 |
| Entity Type | Organization |
| Organization Name | MID OHIO INFECTIOUS DISEASES CLINIC LLC |
| Practice Address |
630 Lexington Ave Mansfield OH 44907-1500 |
| Mailing Address |
Po Box 5096 Mansfield OH 44901-5096 |
| Practice Telephone | 4127081608 |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2009-07-16 |
| Authorized Official Name | DR. UCHENNA A EZIKE (OWNER/PRESIDENT) |
| Authorized Official Telephone | 4127081608 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
35093594 | OH | Ambulatory Health Care Facilities |
| Street Address |
630 LEXINGTON AVE |
| City | MANSFIELD |
| State | OH |
| Zip Code | 44907-1500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124036470 | Michael Robert Leech | Dentist | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2006-08-03 |
| 1265042774 | Jessica Gooden | Physical Therapist | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2020-08-10 |
| 1760003891 | Dynamic Dental Specialists, LLC | Dentist | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2020-04-29 |
| 1114484359 | Ryan M Rundle | Physical Therapist | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2019-02-25 |
| 1306340567 | Oakwood Oral and Maxillofacial Surgery, Christopher N. Beale, Dds, LLC | Dentist | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2018-03-22 |
| 1306077656 | Timothy Scott Bartholomew | Dentist | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2009-08-05 |
| 1285896803 | Bruce A. Martin, M.d., L.L.C. | Internal Medicine | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2008-06-25 |
| 1841382728 | Edwin Lee Farrar | Dentist | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2006-09-29 |
| 1730271529 | Gary Ernest Owens | Dentist | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2006-09-29 |
| 1780776575 | Edwin L Farrar, Dds Inc | Dentist | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2006-09-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053932434 | Kerri Nichole Tolliver | Licensed Practical Nurse | Mansfield Comprehensive Treatment Center, 475 Lexington Ave, Mansfield, OH 44907 | 2020-04-27 |
| 1790325371 | Gabrielle Smith | Licensed Practical Nurse | 707 Scholl Rd, Mansfield, OH 44907 | 2020-01-10 |
| 1912544982 | Heidi L Mathews | Behavior Technician | 270 Sterkel Blvd., Mansfield, OH 44907 | 2019-12-09 |
| 1851942254 | Misty J Kline | Licensed Practical Nurse | 707 Scholl Rd., Mansfield, OH 44907 | 2019-09-26 |
| 1528533320 | Ohio Treatment Center, LLC | Clinic/Center | 475 Lexington Ave., Mansfield, OH 44907 | 2018-10-08 |
| 1750898722 | Hannah Rose Hardin | Behavior Technician | 1033 Larchwood R, Mansfield, OH 44907 | 2017-12-29 |
| 1932548856 | Jessica Alexis Taylor | Counselor | 641 Scholl Rd., Mansfield, OH 44907 | 2013-06-25 |
| 1336495258 | Sonal Sinha | Psychiatry & Neurology | 341 Cline Ave Ste 1, Mansfield, OH 44907 | 2012-07-29 |
| 1427321579 | Tara Kightlinger | Community Health Worker | 442 Brenda Dr, Mansfield, OH 44907 | 2012-02-21 |
| 1649557620 | William Scott Olar | Chiropractor | 1179 Lexington Ave, Mansfield, OH 44907 | 2011-11-04 |
| Find all providers in zip 44907 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
| 1982945127 | Hospitalist Partners of Excellence In Mansfield (h.o.p.e), P.a. | Clinic/Center | 2800 E Broad St, Suite 308, Mansfield, TX 76063-6412 | 2013-03-13 |
| 1417191636 | Mansfield Plastic Surgery, LLC | Clinic/Center | 370 Cline Ave, Mansfield, OH 44907-1057 | 2009-05-01 |
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| 1730703547 | Ohio Restorative Medicine | Clinic/Center | 7242 Tylers Corner Dr Ste B, West Chester, OH 45069-6335 | 2020-06-08 |
| 1982223657 | The Dahlia Center, LLC | Clinic/Center | 3637 Medina Rd Ste 85, Medina, OH 44256-8153 | 2020-04-13 |
| 1669940722 | Wilmington Chiropractic and Wellness Center LLC | Clinic/Center | 576 Prairie Ave, Wilmington, OH 45177-1770 | 2018-11-07 |
| 1093201246 | Central Ohio Nephrology and Hypertension Clinic LLC | Clinic/Center | 550 S Cleveland Ave Ste A, Westerville, OH 43081-8958 | 2018-07-10 |
| 1518452010 | Endovascular Associates LLC | Clinic/Center | 8790 E Market St Ste 300, Warren, OH 44484-2360 | 2018-06-27 |
| 1154833655 | Next Level Sport and Spine LLC | Clinic/Center | 204 W. High Ave, New Philadelphia, OH 44663 | 2017-10-25 |
| 1275927840 | Alliance Recovery Specialists LLC | Clinic/Center | 2371 W State St, Suite A, Alliance, OH 44601-3594 | 2015-03-23 |
| 1356742407 | Reeshad R Buhariwalla, Md Inc | Clinic/Center | 4090 Acadia Rd, Delphos, OH 45833-9410 | 2014-09-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.