Provider Demographics
NPI: | 1144217894 |
---|---|
Name: | TOLEDO CLINIC INCORPORATED |
Entity Type: | Organization |
Organization Name: | TOLEDO CLINIC INCORPORATED |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF OPERATING OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TOM |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SYLAK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 419-473-3561 |
Mailing Address - Street 1: | 4235 SECOR RD |
Mailing Address - Street 2: | |
Mailing Address - City: | TOLEDO |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43623-4231 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 419-473-3561 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4235 SECOR RD |
Practice Address - Street 2: | TOLEDO CLINIC INC |
Practice Address - City: | TOLEDO |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43623-4231 |
Practice Address - Country: | US |
Practice Address - Phone: | 419-473-3561 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-09-28 |
Last Update Date: | 2024-01-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 207KA0200X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | Group - Multi-Specialty |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty | |
No | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | Group - Multi-Specialty |
No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty | |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 8822117 | Medicaid | |
OH | 0282450007 | Medicare NSC | |
OH | 0282450003 | Medicare NSC | |
OH | 0282450005 | Medicare NSC | |
OH | 9121521 | Medicare PIN | |
OH | 8822117 | Medicaid | |
OH | 0282450001 | Medicare NSC |