NPIMap

Organization Active NPI

Promedica Central Physicians, LLC

  • Family Medicine Physician
  • Maumee, OH
National Provider Identifier
1962543702
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PROMEDICA CENTRAL PHYSICIANS, LLC
Practice address
660 Beaver Creek Cir
Suite 110
Maumee, OH 43537-1745
Phone
(419) 891-6210
Fax
(419) 893-3232
NPI assigned
Feb 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kenya Dixon
Title
Credentialing Assistant
Phone
(419) 824-7288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

660 Beaver Creek Cir
Suite 110
Maumee, OH 43537-1745

Mailing address

660 Beaver Creek Cir
Suite 110
Maumee, OH 43537-1745
Phone (419) 891-6210

Other names 1

  • Arrowhead Family Physicians Doing business as

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
36D2096730Promedica Physicians Arrowhead Family660 Beaver Creek Circle #130, Maumee, OH 43537Certificate of waiverMay 31, 2027

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962543702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 BEAVER CREEK CIR",
            "address_2": "SUITE 110",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371745",
            "telephone_number": "419-891-6210",
            "fax_number": "419-893-3232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 BEAVER CREEK CIR",
            "address_2": "SUITE 110",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371745",
            "telephone_number": "419-891-6210",
            "fax_number": "419-893-3232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CENTRAL PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "KENYA",
        "authorized_official_title_or_position": "CREDENTIALING ASSISTANT",
        "authorized_official_telephone_number": "419-824-7288"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arrowhead Family Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maumee, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.