NPIMap

Organization Active NPI

Promedica Genito-Urinary Surgeons LLC

  • Urology Physician
  • Bowling Green, OH
National Provider Identifier
1386071652
Registry record updated Oct 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
PROMEDICA GENITO-URINARY SURGEONS LLC
Practice address
970 W Wooster St
Suite 129
Bowling Green, OH 43402-2643
Phone
(419) 353-1239
Fax
(419) 353-8364
NPI assigned
Oct 2, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2013

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

Authorized official

Name
Amy L Dwyer
Title
Credentialing Supervisor
Phone
(419) 824-7334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X OH Primary

Addresses

Primary practice location

970 W Wooster St
Suite 129
Bowling Green, OH 43402-2643

Mailing address

970 W Wooster St
Suite 129
Bowling Green, OH 43402-2643
Phone (419) 353-1239

National Provider Directory

National Provider Directory
Tax ID family
Promedica Genito-Urinary Surgeons LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1386071652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 W WOOSTER ST",
            "address_2": "SUITE 129",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434022643",
            "telephone_number": "419-353-1239",
            "fax_number": "419-353-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 W WOOSTER ST",
            "address_2": "SUITE 129",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434022643",
            "telephone_number": "419-353-1239",
            "fax_number": "419-353-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA GENITO-URINARY SURGEONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-02",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "DWYER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "419-824-7334"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; 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.