NPIMap

Organization Active NPI

Promedica Central Physicians, LLC

Doing business as Pediatric and Adolescent Gastroenterology and Nutrition Team

  • Pediatric Gastroenterology Physician
  • Toledo, OH
National Provider Identifier
1144365669
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
Legal business name
PROMEDICA CENTRAL PHYSICIANS, LLC
Doing business as
Pediatric and Adolescent Gastroenterology and Nutrition Team
Practice address
2109 Hughes Dr
Suite 860
Toledo, OH 43606-3856
Phone
(419) 291-7010
Fax
(419) 479-6917
NPI assigned
Feb 21, 2007
Last updated
Jul 21, 2022By the provider in NPPES
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 Govan
Title
Credentialing Specialist
Phone
(419) 824-7221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X OH Primary

Addresses

Primary practice location

2109 Hughes Dr
Suite 860
Toledo, OH 43606-3856

Mailing address

2109 Hughes Dr
Suite 860
Toledo, OH 43606-3856
Phone (419) 291-7010

Other identifiers 3

IdentifierTypeStateIssuer
7075625OtherOHAETNA
0999273MedicaidOH
CI3157OtherOHRRMC

Other names 1

  • Pediatric and Adolescent Gastroenterology and Nutrition Team Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Promedica Central Physician LLC75 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

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

View all 22

Locations

2109 Hughes Dr
Ste 860
Toledo, OH 43606
Phone (419) 291-2210

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1144365669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR",
            "address_2": "SUITE 860",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063856",
            "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": "2109 HUGHES DR",
            "address_2": "SUITE 860",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063856",
            "telephone_number": "419-291-7010",
            "fax_number": "419-479-6917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CENTRAL PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GOVAN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "419-824-7221"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7075625",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0999273",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "CI3157",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric and Adolescent Gastroenterology and Nutrition Team",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Toledo, 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.