Provider Demographics
NPI:1164581559
Name:TOLEDO SLEEP DISORDERS CENTER LTD
Entity Type:Organization
Organization Name:TOLEDO SLEEP DISORDERS CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-794-1105
Mailing Address - Street 1:1661 HOLLAND RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4207
Mailing Address - Country:US
Mailing Address - Phone:419-794-8200
Mailing Address - Fax:419-724-1892
Practice Address - Street 1:1661 HOLLAND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4207
Practice Address - Country:US
Practice Address - Phone:419-794-8200
Practice Address - Fax:419-724-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9320631Medicare PIN