Healthcare Provider Details

I. General information

NPI: 1861517211
Provider Name (Legal Business Name): PROMEDICA CENTRAL PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 HUGHES DR SUITE 710
TOLEDO OH
43606-3845
US

IV. Provider business mailing address

2121 HUGHES DR SUITE 710
TOLEDO OH
43606-3845
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3858
  • Fax: 419-480-8701
Mailing address:
  • Phone: 419-291-3858
  • Fax: 419-480-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: KIMBERLY GOVAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 419-824-7221