Provider Demographics
NPI:1538267513
Name:MID-OHIO ONCOLOGY HEMATOLOGY INC
Entity type:Organization
Organization Name:MID-OHIO ONCOLOGY HEMATOLOGY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PFAFF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-383-6168
Mailing Address - Street 1:3100 PLAZA PROPERTIES BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219
Mailing Address - Country:US
Mailing Address - Phone:614-383-6168
Mailing Address - Fax:614-383-6169
Practice Address - Street 1:3100 PLAZA PROPERTIES BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1530
Practice Address - Country:US
Practice Address - Phone:614-383-6168
Practice Address - Fax:614-383-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
OHPMY021551100033336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2080477OtherPK
OH2686446Medicaid
2080477OtherPK