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General NPI Number Information
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NPI Number | 1730371600
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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 | 08/15/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 22 TURTLE CREEK CIR SUITE E
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City | SWANTON
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State | OH
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Zip | 43558-8591
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Country | US
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Telephone | 419-825-2387
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Fax | 419-825-3783
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Provider Business Mailing Address
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Address Line | 22 TURTLE CREEK CIR SUITE E
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City | SWANTON
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State | OH
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Zip | 43558-8591
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Country | US
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Telephone | 419-825-2387
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Fax | 419-825-3783
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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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 | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 35086025
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License Number State | OH
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