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General NPI Number Information
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NPI Number | 1871912410
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Entity Type | Organization
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Legal Business Name | PROMEDICA CENTRAL PHYSICIANS
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 5700 MONROE ST UNIT 211
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City | SYLVANIA
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State | OH
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Zip | 43560-2737
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Country | US
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Telephone | 419-776-1004
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Fax | 419-776-1020
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Provider Business Mailing Address
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Address Line | 100 MADISON AVE FL 3
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City | TOLEDO
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State | OH
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Zip | 43604-1516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TANYA WINES
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Credential |
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Telephone | 567-585-0422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State | OH
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