Organization
PROMEDICA CENTRAL PHYSICIANS,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY GOVAN (CREDENTIALING COORDINATOR)
(419) 824-7221
Entity
Organization
Contact information
Practice address
1601 BRIGHAM DR, SUITE 250A, PERRYSBURG, OH 43551-7114
(419) 872-7760
(419) 874-8657
Mailing address
1601 BRIGHAM DR, SUITE 250A, PERRYSBURG, OH 43551-7114
(419) 872-7760
(419) 874-8657
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
34007277
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PEMDING
—
OH
01
—
PENDING
AETNA
OH
Enumeration date
08/15/2007
Last updated
08/15/2007
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