MEDICARE: PROMEDICA CENTRAL PHYSICIANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	156F00000X	Technician/Technologist	OH
2	207W00000X	Ophthalmology Physician	OH
3	152W00000X	Optometrist	OH

General Provider Information

NPI Number	:	1871912410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMEDICA CENTRAL PHYSICIANS

Provider Business Mailing Address
First Line	:	100 MADISON AVE FL 3
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 MONROE ST UNIT 211
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-2737
Country	:	US
Telephone Number	:	419-776-1004
Fax Number	:	419-776-1020

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TANYA WINES
Credential	:
Telephone Number	:	567-585-0422

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	10/13/2025

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