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PROMEDICA CENTRAL PHYSICIANS LLC NPI 1053455170


NPI Information

NPI: 1053455170
Provider Name: PROMEDICA CENTRAL PHYSICIANS, LLC

Doing Business As: PERRYSBURG PEDIATRICS

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 36D0331468

Address:
1601 BRIGHAM DR
SUITE 200
PERRYSBURG, OH
ZIP 43551
Phone: (419) 872-7700
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PROMEDICA CENTRAL PHYSICIANS, LLC is a pediatrics in Perrysburg, OH. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. PROMEDICA CENTRAL PHYSICIANS, LLC NPI is 1053455170. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Perrysburg Pediatrics.

The provider's business location address is:

1601 BRIGHAM DR
SUITE 200
PERRYSBURG, OH
ZIP 43551-114
Phone: (419) 872-7700
Fax: (419) 874-0196

The provider's authorized official is Kimberly A Govan .
The authorized official title is Credentialing Specialist and has the following contact phone number (419) 824-7221.

The CLIA number assigned to this NPI record is 36D0331468 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/20/2007 and was last updated on 7/21/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsOHIOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10999273MEDICAIDOHIO
25835390OTHEROHIOAETNA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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