Organization
PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY BAHNSEN (CREDENTIALING SUPERVISOR)
(419) 824-7334
Entity
Organization
Contact information
Practice address
501 VAN BUREN ST, SUITE 206, FOSTORIA, OH 44830-1534
(419) 435-7734
(419) 436-6623
Mailing address
501 VAN BUREN ST, SUITE 206, FOSTORIA, OH 44830-1534
(419) 435-7734
(419) 436-6623
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
341898679
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
341898679-003
TRICARE
OH
01
—
341898679-03
BWC
OH
01
—
CJ9183
RRMC
OH
Enumeration date
02/28/2007
Last updated
08/12/2011
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