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General NPI Number Information
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NPI Number | 1518202050
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Entity Type | Organization
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Legal Business Name | PROMEDICA CENTRAL PHYSICIANS LLC
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 1912 HAYES AVE
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City | SANDUSKY
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State | OH
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Zip | 44870-4736
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Country | US
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Telephone | 419-557-6767
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Fax | 419-557-6783
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Provider Business Mailing Address
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Address Line | 1912 HAYES AVE
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City | SANDUSKY
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State | OH
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Zip | 44870-4736
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Country | US
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Telephone | 419-557-6767
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Fax | 419-557-6783
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Authorized Official
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Title or Position | CREDENTIALING 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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine 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 | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number |
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License Number State | OH
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