NPIMap

Organization Active NPI

Promedica Central Physicians, LLC

  • Otolaryngology Physician
  • Defiance, OH
National Provider Identifier
1114112273
Registry record updated Feb 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
35.078360 Issued in OH
Legal business name
PROMEDICA CENTRAL PHYSICIANS, LLC
Practice address
1200 Ralston Ave
Defiance, OH 43512-1396
Phone
(419) 783-6847
Fax
(419) 782-7580
NPI assigned
Sep 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2008

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 35.078360 OH Primary

Addresses

Primary practice location

1200 Ralston Ave
Defiance, OH 43512-1396

Mailing address

1200 Ralston Ave
Defiance, OH 43512-1396
Phone (419) 783-6847

Other names 1

  • Northwest Ohio ENT Consultants 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 21

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

View all 21

Locations

1200 Ralston Ave
Defiance, OH 43512
Phone (419) 783-6944

NPI Registry JSON

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203292800000",
    "number": "1114112273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 RALSTON AVE",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435121396",
            "telephone_number": "419-783-6847",
            "fax_number": "419-782-7580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 RALSTON AVE",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435121396",
            "telephone_number": "419-783-6847",
            "fax_number": "419-782-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CENTRAL PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2008-02-18",
        "status": "A",
        "authorized_official_last_name": "GOVAN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "419-824-7221"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "OH",
            "license": "35.078360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Ohio ENT Consultants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Defiance, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2008; 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.