PROMEDICA CORPORATION OF MICHIGAN (NPI# 1790812907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790812907 |
| Entity Type | Organization |
| Organization Name | PROMEDICA CORPORATION OF MICHIGAN |
| Other Organization Name | KEENER, DEMOTS AND RHAMES |
| Practice Address |
777 Kimole Ln Suite 230 Adrian MI 49221-1478 |
| Practice Telephone | 5172635655 |
| Practice Fax Number | 5172638012 |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | KIMBERLY GOVAN (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 4198247221 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | ========= | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | RRMC | CD9268 | 01 |
| Other Name | Type Code |
|---|---|
| Keener, DeMots and Rhames | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518094721 | Promedica Corporation of Michigan | Internal Medicine | 13101 Sims Hwy, Morenci, MI 49256-1030 | 2007-02-27 |
| 1316073703 | Promedica Corporation of Michigan | Family Medicine | 9205 East Us Highway 23, Blissfield, MI 49228 | 2007-02-27 |
| 1689945172 | Promedica Corporation of Michigan | Otolaryngology | 240 W Carleton Rd, Hillsdale, MI 49242-5034 | 2012-01-16 |
| 1083981302 | Promedica Corporation of Michigan | Internal Medicine | 157 W Brooke Ln, Blissfield, MI 49228-8601 | 2011-12-01 |
| 1154548592 | Promedica Corporation of Michigan | Obstetrics & Gynecology | 901 Kimole Ln, Suite A-1, Adrian, MI 49221-1491 | 2007-04-19 |
| 1477689859 | Promedica Corporation of Michigan | Family Medicine | 901 Kimole Ln, Suite A-4, Adrian, MI 49221-1491 | 2007-02-27 |
| 1780711002 | Promedica Corporation of Michigan | Internal Medicine | 1671 W Michigan Ave, Suite A, Clinton, MI 49236-8702 | 2007-02-27 |
| 1942336326 | Promedica Corporation of Michigan | Surgery | 10 Cairns St, Tecumseh, MI 49286-1202 | 2007-02-27 |
| 1588791925 | Promedica Corporation of Michigan | Internal Medicine | 818 Riverside Ave, 5th Floor Cardiology, Adrian, MI 49221-1446 | 2007-02-27 |
| 1982731204 | Promedica Corporation of Michigan | Obstetrics & Gynecology | 501 E Cummins St, Tecumseh, MI 49286-2070 | 2007-02-27 |
| Street Address |
777 KIMOLE LN SUITE 230 |
| City | ADRIAN |
| State | MI |
| Zip Code | 49221-1478 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972501138 | Heidi Nichols | Nurse Practitioner | 777 Kimole Ln, Adrian, MI 49221-1478 | 2005-07-12 |
| 1023470614 | Emily Grace Corfman | Speech-Language Pathologist | 777 Kimole Ln, Suite 110, Adrian, MI 49221-1478 | 2016-03-23 |
| 1083098420 | Sarah Farmer | Nurse Practitioner | 777 Kimole Ln, Suite 230, Adrian, MI 49221-1478 | 2015-07-15 |
| 1194096693 | Promedica Central Physicians | Internal Medicine | 777 Kimole Ln, Suite 250, Adrian, MI 49221-1478 | 2012-01-16 |
| 1376721035 | Konda Bc Mouli, Md PC | Urology | 777 Kimole Ln, Suite 260, Adrian, MI 49221-1478 | 2008-02-05 |
| 1689863391 | Anne Elisabeth Butts | Nurse Practitioner | 777 Kimole Ln, Ste. 260, Adrian, MI 49221-1478 | 2007-10-18 |
| 1285826008 | Annemarie Marwitz Kallenbach | Nurse Practitioner | 777 Kimole Ln, Adrian, MI 49221-1478 | 2007-08-15 |
| 1336276542 | Promedica Corporation of Michigan | Otolaryngology | 777 Kimole Ln, Suite 240, Adrian, MI 49221-1478 | 2007-02-27 |
| 1093840381 | Promedica Corporation of Michigan | Surgery | 777 Kimole Ln, Suite 220, Adrian, MI 49221-1478 | 2007-02-23 |
| 1255483038 | Toledo Clinic Incorporated | Durable Medical Equipment & Medical Supplies | 777 Kimole Ln, Suite 130, Adrian, MI 49221-1478 | 2007-01-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285116723 | Sandra Ann Harsh | Occupational Therapist | Total Rehab, 1136 Country Club, Adrian, MI 49221 | 2018-08-31 |
| 1588156178 | Chelsea Varney | Social Worker | 1040 Winter Street, Adrian, MI 49221 | 2018-05-31 |
| 1669974127 | Nicoletta Mary Bruno | Physical Therapy Assistant | 700 Lakeshire Trail, Adrian, MI 49221 | 2018-03-01 |
| 1871011403 | Evan Splan | Pharmacist | 1200 South Main St Suite A, Adrian, MI 49221 | 2017-09-04 |
| 1780104992 | Daniel Malcolm | Specialist/Technologist | 1325 Williams St., Adrian, MI 49221 | 2017-06-20 |
| 1639602881 | Robert Gargol | Pharmacist | 1535 W Maumee, Adrian, MI 49221 | 2017-04-05 |
| 1487196416 | Painless Dentistry V | Dentist | 160 N. Winter St., Adrian, MI 49221 | 2016-11-08 |
| 1487025227 | Michelle Lynn Ranta | Speech-Language Pathologist | 730 Kimole Ln., Adrian, MI 49221 | 2015-10-19 |
| 1376929109 | James Hamblin | Technician, Other | 1100 South Main St. Lot 139, Adrian, MI 49221 | 2015-08-04 |
| 1316320039 | Shirley Goodlock | Community/Behavioral Health | 3091 E. Carleton Rd, Adrian, MI 49221 | 2015-06-30 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265720262 | Aron Alan Gornowicz | Family Medicine | 146 South Charles Street, Adrian, MI 49221 | 2011-07-12 |
| 1235157421 | Tariq A. Siddiqi | Family Medicine | 755 High St, Adrian, MI 49221-1442 | 2006-07-17 |
| 1598729535 | Amy Patton | Family Medicine | 3245 N Adrian Hwy Ste A, Adrian, MI 49221 | 2006-04-14 |
| 1184624934 | Tatiana Masyk | Family Medicine | 901 Kimole Ln, Suite A-4, Adrian, MI 49221-1491 | 2005-07-22 |
| 1205830791 | Nathan P Rud | Family Medicine | 601 Louisiana Ave, Adrian, MN 56110-1051 | 2005-06-13 |
| 1306206578 | Indigo Hospital Medicine - Adrian Plc | Family Medicine | 818 Riverside Ave, Adrian, MI 49221-1446 | 2016-03-02 |
| 1316325129 | Christina Yancey | Family Medicine | 1200 N Main St, Adrian, MI 49221 | 2015-05-12 |
| 1598021164 | Charan Kanwal Cheema | Family Medicine | 781 Lakeshire Trl, Adrian, MI 49221-1561 | 2012-04-08 |
| 1578797494 | Bates County Memorial Hospital | Family Medicine | 102 E. Main, Adrian, MO 64720 | 2009-05-06 |
| 1477689859 | Promedica Corporation of Michigan | Family Medicine | 901 Kimole Ln, Suite A-4, Adrian, MI 49221-1491 | 2007-02-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.