NPIMap

Organization Active NPI

Promedica Genito-Urinary Surgeons LLC

  • Urology Physician
  • Fremont, OH
National Provider Identifier
1477980753
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
605 3Rd Ave Ste a
Suite B
Fremont, OH 43420-3269
Phone
(419) 332-7221
Fax
(419) 332-7225
NPI assigned
Oct 2, 2013
Last updated
Oct 2, 2013By the provider in NPPES
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 Physician 208800000X OH Primary

Addresses

Primary practice location

605 3Rd Ave Ste a
Suite B
Fremont, OH 43420-3269

Mailing address

605 3Rd Ave Ste a
Suite B
Fremont, OH 43420-3269
Phone (419) 332-7221

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D1036971Promedica Physicians Genito-Urinary Surgeons605 3Rd Avenue, Fremont, OH 43420Certificate of waiverSep 30, 2027

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.

Locations

605 3rd Ave
Ste A
Fremont, OH 43420
Phone (419) 332-7221

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": "1477980753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 3RD AVE STE A",
            "address_2": "SUITE B",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434203269",
            "telephone_number": "419-332-7221",
            "fax_number": "419-332-7225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 3RD AVE STE A",
            "address_2": "SUITE B",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434203269",
            "telephone_number": "419-332-7221",
            "fax_number": "419-332-7225"
        }
    ],
    "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": "",
            "desc": "Urology",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.