# MID OHIO MEDICAL MANAGEMENT,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497916605
- **Authorized official:** GINA MARIE NICHOLS MD (CEO)
- **Authorized official phone:** (614) 834-7030

## Contact information

- **Practice address:** 1755 LANCASTER AVE, REYNOLDSBURG, OH 43068
- **Practice address phone:** (614) 834-7030
- **Practice address fax:** (614) 834-7032
- **Mailing address:** PO BOX 513, PICKERINGTON, OH 43147-0513
- **Mailing address phone:** (614) 834-7030
- **Mailing address fax:** (614) 834-7032

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 35086704 | OH | Yes |

## Other

- **Enumeration date:** 06/19/2008
- **Last updated:** 05/25/2018