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General NPI Number Information
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NPI Number | 1457632309
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Entity Type | Organization
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Legal Business Name | PROMEDICA CENTRAL PHYSICIANS
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 1601 BRIGHAM DR SUITE 150
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City | PERRYSBURG
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State | OH
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Zip | 43551-7114
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Country | US
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Telephone | 419-872-7246
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Fax | 419-872-3754
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Provider Business Mailing Address
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Address Line | 1601 BRIGHAM DR SUITE 150
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City | PERRYSBURG
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State | OH
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Zip | 43551-7114
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Country | US
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Telephone | 419-872-7246
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Fax | 419-872-3754
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | AMY L BAHNSEN
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Credential |
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Telephone | 419-824-7334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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