Organization
MID OHIO MEDICAL MANAGEMENT,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA MARIE NICHOLS MD (CEO)
(614) 834-7030
Entity
Organization
Contact information
Practice address
1755 LANCASTER AVE, REYNOLDSBURG, OH 43068
(614) 834-7030
(614) 834-7032
Mailing address
PO BOX 513, PICKERINGTON, OH 43147-0513
(614) 834-7030
(614) 834-7032
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35086704
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2611267
—
OH
Enumeration date
06/19/2008
Last updated
05/25/2018
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