Organization
PROMEDICA CENTRAL PHYSICIANS, LLC
Active
Other names
Perrysburg Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY A GOVAN (CREDENTIALING SPECIALIST)
(419) 824-7221
Entity
Organization
Contact information
Practice address
1601 BRIGHAM DR, SUITE 200, PERRYSBURG, OH 43551-7114
(419) 872-7700
(419) 874-0196
Mailing address
1601 BRIGHAM DR, SUITE 200, PERRYSBURG, OH 43551-7114
(419) 872-7700
(419) 874-0196
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0999273
—
OH
01
—
5835390
AETNA
OH
Enumeration date
02/20/2007
Last updated
07/21/2022
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