Healthcare Provider Details

I. General information

NPI: 1871015578
Provider Name (Legal Business Name): MAGRUDER MEDICAL GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 FULTON ST STE E
PORT CLINTON OH
43452-2008
US

IV. Provider business mailing address

615 FULTON ST
PORT CLINTON OH
43452-2001
US

V. Phone/Fax

Practice location:
  • Phone: 419-734-4539
  • Fax: 419-734-6365
Mailing address:
  • Phone: 419-734-3131
  • Fax: 419-732-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JON T ALMENDINGER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 419-734-3131