NPIMap

Organization Active NPI

Promedica Central Physicians,LLC

  • Obstetrics & Gynecology Physician
  • Perrysburg, OH
National Provider Identifier
1285826156
Registry record updated Aug 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
34007277 Issued in OH
Legal business name
PROMEDICA CENTRAL PHYSICIANS,LLC
Practice address
1601 Brigham Dr
Suite 250a
Perrysburg, OH 43551-7114
Phone
(419) 872-7760
Fax
(419) 874-8657
NPI assigned
Aug 15, 2007
Last updated
Aug 15, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2007

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 34007277 OH Primary

Addresses

Primary practice location

1601 Brigham Dr
Suite 250a
Perrysburg, OH 43551-7114

Mailing address

1601 Brigham Dr
Suite 250a
Perrysburg, OH 43551-7114
Phone (419) 872-7760

Other identifiers 4

IdentifierTypeStateIssuer
PENDINGOtherOHAETNA
PENDINGOtherOHTRICARE
PEMDINGMedicaidOH
PENDINGOtherOHMMOH

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 24

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

View all 24

Locations

1601 Brigham Dr
Ste 250A
Perrysburg, OH 43551
Phone (419) 872-7760

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187136000000",
    "number": "1285826156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 BRIGHAM DR",
            "address_2": "SUITE 250A",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435517114",
            "telephone_number": "419-872-7760",
            "fax_number": "419-874-8657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 BRIGHAM DR",
            "address_2": "SUITE 250A",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435517114",
            "telephone_number": "419-872-7760",
            "fax_number": "419-874-8657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CENTRAL PHYSICIANS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-15",
        "last_updated": "2007-08-15",
        "status": "A",
        "authorized_official_last_name": "GOVAN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "419-824-7221"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "34007277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "PENDING",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "PENDING",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PEMDING",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MMOH",
            "identifier": "PENDING",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 15, 2007; 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.