Healthcare Provider Details

I. General information

NPI: 1992725766
Provider Name (Legal Business Name): CLINICAL COLLEAGUES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S WASHINGTON ST
VAN WERT OH
45891-2551
US

IV. Provider business mailing address

PO BOX 824246
PHILADELPHIA PA
19182-4246
US

V. Phone/Fax

Practice location:
  • Phone: 850-985-9180
  • Fax:
Mailing address:
  • Phone: 850-985-9180
  • Fax: 954-545-3497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberUNKNOWN
License Number State

VIII. Authorized Official

Name: KURT ZUMWALT
Title or Position: CEO
Credential:
Phone: 844-937-1810