Provider Demographics
NPI:1174563670
Name:MID AMERICAN IMAGING, INC.
Entity type:Organization
Organization Name:MID AMERICAN IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP CORPORATE FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:POAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-242-5321
Mailing Address - Street 1:100 BAYVIEW CIRCLE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2984
Mailing Address - Country:US
Mailing Address - Phone:800-544-3215
Mailing Address - Fax:
Practice Address - Street 1:659 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2026
Practice Address - Country:US
Practice Address - Phone:330-343-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02220180040261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000166606OtherANTHEM BCBS OF OHIO
OH2368727Medicaid
OH366270200OtherACS/US DEPT OF LABOR
OH47710-0001Medicaid
OH23753OtherMEDFOCUS RADIOLOGY NETWOR
OH731337Medicaid
OH23753OtherMEDFOCUS RADIOLOGY NETWOR
OH000000166606OtherANTHEM BCBS OF OHIO
OH366270200OtherACS/US DEPT OF LABOR
OH2368727Medicaid
OH=========-03OtherOHIO BWC