NPIMap

Organization Active NPI

Promedica Central Physicians LLC

  • Pediatric Gastroenterology Physician
  • Monroe, MI
National Provider Identifier
1083959522
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
Legal business name
PROMEDICA CENTRAL PHYSICIANS LLC
Practice address
730 N Macomb St
Suite 300
Monroe, MI 48162-2900
Phone
(419) 291-7010
Fax
(419) 479-6917
NPI assigned
Dec 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

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

Authorized official

Name
Kristin Knueven
Title
Credentialing Supervisor
Phone
(567) 585-1969

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0206X MI Primary

Addresses

Primary practice location

730 N Macomb St
Suite 300
Monroe, MI 48162-2900

Mailing address

730 N Macomb St
Suite 300
Monroe, MI 48162-2900
Phone (419) 291-7010

Other names 1

  • ProMedica Children's Specialties Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Promedica Central Physicians LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1083959522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 N MACOMB ST",
            "address_2": "SUITE 300",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481622900",
            "telephone_number": "419-291-7010",
            "fax_number": "419-479-6917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 N MACOMB ST",
            "address_2": "SUITE 300",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481622900",
            "telephone_number": "419-291-7010",
            "fax_number": "419-479-6917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CENTRAL PHYSICIANS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-11",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "KNUEVEN",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "567-585-1969"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProMedica Children's Specialties",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProMedica Children's Specialties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; 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.