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NPI Code Detail

MEDICARE: PROMEDICA CENTRAL PHYSICIANS,LLC

MEDICARE: PROMEDICA CENTRAL PHYSICIANS,LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VM0101XMaternal & Fetal Medicine Physician35086025OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14036950014OTHEROHDMERC
2PENDINGOTHEROHMMOH
3PENDINGOTHEROHPARAMOUNT
4PENDINGOTHEROHTRICARE
5PENDINGOTHEROHAETNA

General Provider Information

NPI Number : 1730371600
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROMEDICA CENTRAL PHYSICIANS,LLC
Provider Business Mailing Address
First Line : 22 TURTLE CREEK CIR
Second Line : SUITE E
City : SWANTON
State : OH
Zip : 43558-8591
Country : US
Telephone Number : 419-825-2387
Fax Number : 419-825-3783
Provider Business Practice Location Address
First Line : 22 TURTLE CREEK CIR
Second Line : SUITE E
City : SWANTON
State : OH
Zip : 43558-8591
Country : US
Telephone Number : 419-825-2387
Fax Number : 419-825-3783
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : KIMBERLY GOVAN
Credential :
Telephone Number : 419-824-7221
Provider Enumeration Date : 08/15/2007
Last Update Date : 11/29/2007

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