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General NPI Number Information
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NPI Number | 1992820302
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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 | 03/21/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2150 W CENTRAL AVE
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City | TOLEDO
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State | OH
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Zip | 43606-3846
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Country | US
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Telephone | 419-291-8720
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Fax |
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Provider Business Mailing Address
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Address Line | 5855 MONROE ST
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City | SYLVANIA
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State | OH
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Zip | 43560-2269
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Country | US
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Telephone | 419-824-7221
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Fax | 419-824-7359
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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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 | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | OH
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