Organization
MEDCENTRAL PROFESSIONAL FOUNDATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH L CHAMBERLAIN (CEO/CFO)
(419) 526-8000
Entity
Organization
Contact information
Practice address
308 GLESSNER AVENUE, MANSFIELD, OH 44903-2269
(419) 526-8962
(419) 526-8834
Mailing address
335 GLESSNER AVE, MANSFIELD, OH 44903-2269
(419) 526-8962
(419) 526-8834
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
35-07-2694-D
OH
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207T00000X
Neurological Surgery Physician
35090672
OH
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
208600000X
Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2810131
—
OH
Enumeration date
01/18/2008
Last updated
09/17/2013
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