Organization
PROMEDICA CENTRAL PHYSICIANS LLC
Active
Other names
PROMEDICA AFTER HOURS
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN KNUEVEN (CREDENTIALING COORDINATOR)
(419) 824-7469
Entity
Organization
Contact information
Practice address
1601 BRIGHAM DR, SUITE 150, PERRYSBURG, OH 43551-7114
(419) 291-0130
(419) 872-5396
Mailing address
5855 MONROE ST, SYLVANIA, OH 43560-2269
(419) 824-7469
(419) 824-7359
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
OH
363L00000X
Nurse Practitioner
Primary
—
OH
363LF0000X
Family Nurse Practitioner
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0999273
—
OH
Enumeration date
09/27/2013
Last updated
09/27/2013
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