NPIMap

Organization Active NPI

Promedica Central Physicians LLC

  • Nurse Practitioner
  • Perrysburg, OH
National Provider Identifier
1588091292
Registry record updated Sep 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PROMEDICA CENTRAL PHYSICIANS LLC
Practice address
1601 Brigham Dr
Suite 150
Perrysburg, OH 43551-7114
Phone
(419) 291-0130
Fax
(419) 872-5396
NPI assigned
Sep 27, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2013

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

Authorized official

Name
Kristin Knueven
Title
Credentialing Coordinator
Phone
(419) 824-7469

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X OH
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X OH Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X OH

Addresses

Primary practice location

1601 Brigham Dr
Suite 150
Perrysburg, OH 43551-7114

Mailing address

5855 Monroe St
Sylvania, OH 43560-2269
Phone (419) 824-7469

Other identifiers 1

IdentifierTypeStateIssuer
0999273MedicaidOH

Other names 1

  • PROMEDICA AFTER HOURS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Promedica Central Physi75 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 150
Perrysburg, OH 43551
Phone (419) 794-7700

NPI Registry JSON

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

{
    "created_epoch": "1380240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380240000000",
    "number": "1588091292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 MONROE ST",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602269",
            "telephone_number": "419-824-7469",
            "fax_number": "419-824-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 BRIGHAM DR",
            "address_2": "SUITE 150",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435517114",
            "telephone_number": "419-291-0130",
            "fax_number": "419-872-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CENTRAL PHYSICIANS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-27",
        "last_updated": "2013-09-27",
        "status": "A",
        "authorized_official_last_name": "KNUEVEN",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "419-824-7469"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0999273",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROMEDICA AFTER HOURS",
            "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 Sep 27, 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.