Healthcare Provider Details

I. General information

NPI: 1912208729
Provider Name (Legal Business Name): PROHEALTH PHYSICIAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12611 ECKEL JUNCTION RD
PERRYSBURG OH
43551-1304
US

IV. Provider business mailing address

12611 ECKEL JUNCTION RD
PERRYSBURG OH
43551-1304
US

V. Phone/Fax

Practice location:
  • Phone: 877-511-9739
  • Fax: 866-437-9066
Mailing address:
  • Phone: 877-511-9739
  • Fax: 866-437-9066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RITCHIE ADAMS
Title or Position: OWNER/CEO
Credential:
Phone: 419-491-7150