Provider Demographics
NPI:1508189499
Name:SENIOR CARE PHYSICIANS, INC.
Entity Type:Organization
Organization Name:SENIOR CARE PHYSICIANS, INC.
Other - Org Name:SENIOR CARE PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE, TREASURER & CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:UNVERFERTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-999-2010
Mailing Address - Street 1:1100 SHAWNEE ROAD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805
Mailing Address - Country:US
Mailing Address - Phone:419-999-2010
Mailing Address - Fax:419-999-6284
Practice Address - Street 1:1745 INDIAN WOOD CIR STE 252
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4168
Practice Address - Country:US
Practice Address - Phone:419-491-4395
Practice Address - Fax:419-932-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2018-03-26
Deactivation Date:2012-10-24
Deactivation Code:
Reactivation Date:2017-12-19
Provider Licenses
StateLicense IDTaxonomies
OH207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty