Organization
MID AMERICAN IMAGING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA LONGMORE GRUND (EXEC VP & CFO)
(800) 544-3215
Entity
Organization
Contact information
Practice address
1400 E 2ND ST, DEFIANCE, OH 43512-2440
(419) 783-3239
Mailing address
100 BAYVIEW CIRCLE, SUITE 400, NEWPORT BEACH, CA 92660-2984
(800) 544-3215
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
02220180040
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000166606
ANTHEM BC/BS OF OHIO
OH
01
—
000000268775
ANTHEM BC/BS OF OHIO
OH
01
—
104395
KAISER
OH
01
—
20043
MED FOCUS RADIOLOGY NETWO
OH
05
—
2154823
—
OH
05
—
2284184
—
OH
01
—
23752
MED FOCUS RADIOLOGY NETWO
OH
01
—
26308
MEDFOCUS RADIOLOGY NETWOR
OH
01
—
366270200
ACS/US DEPT OF LABOR
OH
01
—
731337
BUCKEYE COMM HEALTH PLAN
OH
Enumeration date
06/07/2006
Last updated
10/19/2016
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