Healthcare Provider Details

I. General information

NPI: 1720798101
Provider Name (Legal Business Name): WEST CENTRAL OHIO UROLOGICAL CENTERS OF EXCELLENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 FORT AMANDA RD
LIMA OH
45805-4805
US

IV. Provider business mailing address

1365 SHOREVIEW DR
LIMA OH
45805-3684
US

V. Phone/Fax

Practice location:
  • Phone: 419-855-5119
  • Fax: 419-614-6027
Mailing address:
  • Phone: 419-855-5119
  • Fax: 419-614-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CRAIG ALAN NICHOLSON
Title or Position: OWNER
Credential:
Phone: 567-529-9000