Provider Demographics
NPI:1063551539
Name:MEDSTAT OF OHIO, CORP.
Entity type:Organization
Organization Name:MEDSTAT OF OHIO, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-322-9075
Mailing Address - Street 1:113 N HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1308
Mailing Address - Country:US
Mailing Address - Phone:614-322-9075
Mailing Address - Fax:614-322-9064
Practice Address - Street 1:113 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-1308
Practice Address - Country:US
Practice Address - Phone:614-322-9075
Practice Address - Fax:614-322-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2581684Medicaid
OH2581684Medicaid