NPIMap

Organization Active NPI

Great Lakes Medical Services LLC

  • Urgent Care Clinic/Center
  • Perrysburg, OH
National Provider Identifier
1184705121
Registry record updated May 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
1515723 Issued in OH
Legal business name
GREAT LAKES MEDICAL SERVICES LLC
Practice address
25660 Dixie Hwy
Perrysburg, OH 43551-2167
Phone
(419) 872-5343
Fax
(419) 872-2465
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2009

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

Authorized official

Name
Mr. Kyle Prueter
Title
President
Phone
(419) 872-5343

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X 1515723 OH Primary

Addresses

Primary practice location

25660 Dixie Hwy
Perrysburg, OH 43551-2167

Mailing address

25660 Dixie Hwy
Perrysburg, OH 43551-2167
Phone (419) 872-5343

Other names 1

  • Great Lakes Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050525000695 OH Part B Supplier - Clinic/Group Practice 9830131382 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Perrysburg, OH

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Medical Services Dba Great Lakes Urgent Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

25660 Dixie Hwy
Ste B
Perrysburg, OH 43551
Phone (419) 872-5343

25660 Dixie Hwy
Perrysburg, OH 43551
Phone (419) 872-5343

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241136000000",
    "number": "1184705121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25660 DIXIE HWY",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435512167",
            "telephone_number": "419-872-5343",
            "fax_number": "419-872-2465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25660 DIXIE HWY",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435512167",
            "telephone_number": "419-872-5343",
            "fax_number": "419-872-2465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2009-05-01",
        "status": "A",
        "authorized_official_last_name": "PRUETER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-872-5343",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "OH",
            "license": "1515723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Urgent Care",
            "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 May 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.