1548461288 NPI number — PROMEDICA CENTRAL PHYSICIANS,LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548461288 NPI number — PROMEDICA CENTRAL PHYSICIANS,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROMEDICA CENTRAL PHYSICIANS,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEDIATRIC PULMONARY ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548461288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 HUGHES DR
Provider Second Line Business Mailing Address:
SUITE 640
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43606-3845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-291-2207
Provider Business Mailing Address Fax Number:
419-479-6998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 HUGHES DR
Provider Second Line Business Practice Location Address:
SUITE 640
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-3845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-291-2207
Provider Business Practice Location Address Fax Number:
419-479-6998
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KNUEVEN
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SUPERVISOR
Authorized Official Telephone Number:
567-585-1969

Provider Taxonomy Codes

  • Taxonomy code: 2080P0214X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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