NPIMap

Organization Active NPI

Promedica Genito-Urinary Surgeons LLC

  • Urology Physician
  • Archbold, OH
National Provider Identifier
1477990893
Registry record updated May 24, 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
121 Westfield Dr
Archbold, OH 43502-1056
Phone
(537) 444-4748
Fax
(567) 444-4750
NPI assigned
May 24, 2013
Last updated
May 24, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 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

121 Westfield Dr
Archbold, OH 43502-1056

Mailing address

121 Westfield Dr
Archbold, OH 43502-1056
Phone (537) 444-4748

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": "1369353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369353600000",
    "number": "1477990893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 WESTFIELD DR",
            "city": "ARCHBOLD",
            "state": "OH",
            "postal_code": "435021056",
            "telephone_number": "537-444-4748",
            "fax_number": "567-444-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 WESTFIELD DR",
            "city": "ARCHBOLD",
            "state": "OH",
            "postal_code": "435021056",
            "telephone_number": "537-444-4748",
            "fax_number": "567-444-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA GENITO-URINARY SURGEONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-24",
        "last_updated": "2013-05-24",
        "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 Archbold, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.