# MID-OHIO VALLEY MEDICAL GROUP, INC

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

## Provider details

- **NPI number:** 1720041171
- **Authorized official:** MRS. LISA G HAYS (OFFICE COORDINATOR)
- **Authorized official phone:** (304) 485-4439

## Contact information

- **Practice address:** 800 GRAND CENTRAL MALL, SUITE 4, VIENNA, WV 26105-4131
- **Practice address phone:** (304) 485-3300
- **Practice address fax:** (304) 485-6489
- **Mailing address:** 800 GRAND CENTRAL MALL, SUITE 4, VIENNA, WV 26105-4131
- **Mailing address phone:** (304) 485-3300
- **Mailing address fax:** (304) 485-3317

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01387 | WV | Yes |

## Other

- **Enumeration date:** 04/07/2006
- **Last updated:** 12/13/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2160325 | — | OH |
| 05 | — | 4000315000 | — | WV |