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General NPI Number Information
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NPI Number | 1912208729
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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 | 11/10/2010
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Last Update Date | 12/30/2020
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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 | 877-511-9739
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Fax | 866-437-9066
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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 | 877-511-9739
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Fax | 866-437-9066
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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