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General NPI Number Information
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NPI Number | 1629119821
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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 | 02/09/2007
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 5300 HARROUN RD SUITE 201
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City | SYLVANIA
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State | OH
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Zip | 43560-2182
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Country | US
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Telephone | 419-885-5688
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Fax | 419-824-1400
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Provider Business Mailing Address
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Address Line | 5300 HARROUN RD SUITE 201
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City | SYLVANIA
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State | OH
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Zip | 43560-2182
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Country | US
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Telephone | 419-885-5688
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Fax | 419-824-1400
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | KIMBERLY GOVAN
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Credential |
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Telephone | 419-824-7221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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