Healthcare Provider Details

I. General information

NPI: 1760523187
Provider Name (Legal Business Name): PROMEDICA CENTRAL PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 N MCCORD RD SUITE 100
TOLEDO OH
43615-1702
US

IV. Provider business mailing address

3020 N MCCORD RD SUITE 100
TOLEDO OH
43615-1702
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-8160
  • Fax: 419-841-7038
Mailing address:
  • Phone: 419-843-8160
  • Fax: 419-841-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: KIMBERLY GOVAN
Title or Position: PRACTICE SERVICES SUPERVISOR
Credential:
Phone: 419-824-7221