Organization
PROMEDICA CENTRAL PHYSICIANS, LLC
Active
Other names
Defiance Orthopaedic Center
Organization subpart
No
Provider details
NPI number
Authorized official
AMY DWYER (CREDENTIALING SUPERVISOR)
(567) 585-1934
Entity
Organization
Contact information
Practice address
1250 RALSTON AVE, SUITE 102, DEFIANCE, OH 43512-5311
(419) 783-6996
(419) 782-8062
Mailing address
1250 RALSTON AVE, SUITE 102, DEFIANCE, OH 43512-5311
(419) 783-6996
(419) 782-8062
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
612540304
DEPARTMENT OF LABOR
—
Enumeration date
02/27/2007
Last updated
01/12/2016
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