Provider Demographics
NPI:1073692802
Name:MID-OHIO MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:MID-OHIO MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLLYEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-252-2191
Mailing Address - Street 1:181 TAYLOR AVE
Mailing Address - Street 2:STE 1501
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1779
Mailing Address - Country:US
Mailing Address - Phone:614-252-2191
Mailing Address - Fax:614-252-2194
Practice Address - Street 1:181 TAYLOR AVE
Practice Address - Street 2:STE 1501
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1779
Practice Address - Country:US
Practice Address - Phone:614-252-2191
Practice Address - Fax:614-252-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0929857Medicaid
OHDG4264OtherRR MEDICARE
OH0929857Medicaid