Healthcare Provider Details

I. General information

NPI: 1326633017
Provider Name (Legal Business Name): PROMEDICA SENIOR CARE MEDICAL SERVICES I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SUMMIT ST FL 15
TOLEDO OH
43604-1531
US

IV. Provider business mailing address

333 N SUMMIT ST FL 15
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 800-427-1902
  • Fax:
Mailing address:
  • Phone: 800-427-1902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTIN ALLEN
Title or Position: DIRECTOR
Credential:
Phone: 419-252-5500