Basic Information
| Provider Information | |||||||||
| NPI: | 1508189499 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENIOR CARE PHYSICIANS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SENIOR CARE PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 SHAWNEE ROAD | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199992010 | ||||||||
| FaxNumber: | 4199996284 | ||||||||
| Practice Location | |||||||||
| Address1: | 1745 INDIAN WOOD CIR STE 252 | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435374168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194914395 | ||||||||
| FaxNumber: | 4199326741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2010 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 10/24/2012 | ||||||||
| NPIReactivationDate: | 12/19/2017 | ||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | UNVERFERTH | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE, TREASURER & CFO | ||||||||
| AuthorizedOfficialTelephone: | 4199992010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.