Provider Demographics
NPI:1568842813
Name:PROMEDICA CENTRAL PHYSICIANS
Entity Type:Organization
Organization Name:PROMEDICA CENTRAL PHYSICIANS
Other - Org Name:PROMEDICA URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-585-0422
Mailing Address - Street 1:3316 NAVARRE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3314
Mailing Address - Country:US
Mailing Address - Phone:419-291-1420
Mailing Address - Fax:419-214-3841
Practice Address - Street 1:3316 NAVARRE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3314
Practice Address - Country:US
Practice Address - Phone:419-291-1420
Practice Address - Fax:419-214-3841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care