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General NPI Number Information
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NPI Number | 1588008403
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Entity Type | Organization
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Legal Business Name | PROHEALTH PHYSICIAN GROUP, LLC
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Dates
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Enumeration Date | 04/22/2013
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 12611 ECKEL JUNCTION RD
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City | PERRYSBURG
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State | OH
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Zip | 43551-1304
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Country | US
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Telephone | 419-873-6326
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Fax |
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Provider Business Mailing Address
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Address Line | 12611 ECKEL JUNCTION RD
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City | PERRYSBURG
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State | OH
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Zip | 43551-1304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | RITCHIE ADAMS
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Credential |
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Telephone | 419-491-7150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 03129
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License Number State | OH
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