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General NPI Number Information
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NPI Number | 1366795221
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Entity Type | Organization
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Legal Business Name | PROMEDICA GENITO-URINARY SURGEONS LLC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 2120 W CENTRAL AVE
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City | TOLEDO
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State | OH
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Zip | 43606-3834
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Country | US
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Telephone | 419-531-8558
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Fax | 419-531-8798
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Provider Business Mailing Address
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Address Line | 100 MADISON AVE MSC-S38805
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City | TOLEDO
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State | OH
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Zip | 43604
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Country | US
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Telephone | 844-373-0871
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Fax | 419-885-3921
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Authorized Official
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Title or Position | SUPERVISOR
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Name | KRISTIN KNUEVEN
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Credential |
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Telephone | 567-585-1969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | OH
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