Organization
MID-OHIO EMERGENCY SERVICES, LLC
Active
Other names
MOES
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY DECKER M.D. (PRESIDENT)
(800) 424-3672
Entity
Organization
Contact information
Practice address
111 S GRANT AVE, COLUMBUS, OH 43215-4701
(614) 566-9000
(614) 566-8072
Mailing address
1643 NW 136TH AVE STE 100, SUNRISE, FL 33323-2857
(800) 424-3672
(954) 377-3042
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000066092
ANTHEM OHIO
OH
01
—
020208900
FEDERAL BLACK LUNG PROGRA
—
01
—
020304100
FEDERAL BLACK LUNG
OH
05
—
2099107
—
OH
05
—
2099116
—
OH
01
—
365758500
US DEPT OF LABOR
OH
01
—
365758501
US DEPT OF LABOR
OH
01
—
CI6323
MEDICARE TRAVELERS RR - G
OH
Enumeration date
05/30/2006
Last updated
06/18/2020
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