# PROMEDICA CENTRAL CORPORATION OF MICHIGAN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588624696
- **Authorized official:** TANYA WINES (DIRECTOR, SYSTEM CREDENTIALING)
- **Authorized official phone:** (567) 585-0422

## Contact information

- **Practice address:** 100 MADISON AVE, MSC-S38805, TOLEDO, OH 43604
- **Practice address phone:** (844) 373-0871
- **Practice address fax:** (419) 885-3921
- **Mailing address:** 100 MADISON AVE, MSC-S38805, TOLEDO, OH 43604
- **Mailing address phone:** (844) 373-0871
- **Mailing address fax:** (419) 885-3921

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | MI | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | MI | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | MI | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | MI | — |
| 207Y00000X | Otolaryngology Physician | — | MI | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | MI | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/23/2006
- **Last updated:** 10/04/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 040D610940 | BCBSMI | MI |
| 01 | — | 080E810210 | BCBSMI | MI |
| 01 | — | 160D610660 | BCBSMI | MI |
| 05 | — | 2002924 | — | OH |
| 01 | — | 500E811000 | BCBSMI | MI |
| 01 | — | CD9268 | RRMC | MI |