Provider Demographics
NPI:1194853556
Name:WEST TOLEDO INTERNAL MEDICINE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:WEST TOLEDO INTERNAL MEDICINE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-517-4000
Mailing Address - Street 1:7640 W SYLVANIA AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9263
Mailing Address - Country:US
Mailing Address - Phone:419-517-4000
Mailing Address - Fax:419-517-4002
Practice Address - Street 1:7640 W SYLVANIA AVE
Practice Address - Street 2:SUITE I
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9263
Practice Address - Country:US
Practice Address - Phone:419-517-4000
Practice Address - Fax:419-517-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH940450OtherUNITHED HEALTH CARE GROUP
OH0855294Medicaid
OH000000165084OtherANTHEM GROUP
OH0855294Medicaid
OH9179673Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
OH000000165084OtherANTHEM GROUP