Provider Demographics
NPI:1669068482
Name:PROMEDICA CENTRAL PHYSICIANS
Entity type:Organization
Organization Name:PROMEDICA CENTRAL PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:100 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1516
Mailing Address - Country:US
Mailing Address - Phone:567-585-1964
Mailing Address - Fax:
Practice Address - Street 1:2865 N REYNOLDS RD BLDG A
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2100
Practice Address - Country:US
Practice Address - Phone:419-578-7017
Practice Address - Fax:567-585-0489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMEDICA CENTRAL PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies