NPIMap

Organization Active NPI

Promedica Central Physicians, LLC

  • Pediatrics Physician
  • Perrysburg, OH
National Provider Identifier
1053455170
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PROMEDICA CENTRAL PHYSICIANS, LLC
Practice address
1601 Brigham Dr
Suite 200
Perrysburg, OH 43551-7114
Phone
(419) 872-7700
Fax
(419) 874-0196
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly A Govan
Title
Credentialing Specialist
Phone
(419) 824-7221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X OH Primary

Addresses

Primary practice location

1601 Brigham Dr
Suite 200
Perrysburg, OH 43551-7114

Mailing address

1601 Brigham Dr
Suite 200
Perrysburg, OH 43551-7114
Phone (419) 872-7700

Other identifiers 2

IdentifierTypeStateIssuer
5835390OtherOHAETNA
0999273MedicaidOH

Other names 1

  • Perrysburg Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Promedica Central Physi75 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1053455170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 BRIGHAM DR",
            "address_2": "SUITE 200",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435517114",
            "telephone_number": "419-872-7700",
            "fax_number": "419-874-0196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 BRIGHAM DR",
            "address_2": "SUITE 200",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435517114",
            "telephone_number": "419-872-7700",
            "fax_number": "419-874-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CENTRAL PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GOVAN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "419-824-7221"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5835390",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0999273",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perrysburg Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Perrysburg, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.