1922422997 NPI number — PROMEDICA GENITO-URINARY SURGEONS LLC

Table of content: (NPI 1922422997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922422997 NPI number — PROMEDICA GENITO-URINARY SURGEONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROMEDICA GENITO-URINARY SURGEONS 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:
CARIN V HOPPS MD
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:
1922422997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 SEAGATE # 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-1558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
567-585-1969
Provider Business Mailing Address Fax Number:
419-824-7359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7640 SYLVANIA AVE
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
SYLVANIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43560-9729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-517-1022
Provider Business Practice Location Address Fax Number:
419-517-1026
Provider Enumeration Date:
02/12/2014

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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