Provider Demographics
NPI:1225015605
Name:RENAL SERVICES OF TOLEDO, INC
Entity Type:Organization
Organization Name:RENAL SERVICES OF TOLEDO, INC
Other - Org Name:RENAL SERVICES OF TOLEDO, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:STOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-698-8560
Mailing Address - Street 1:2702 NAVARRE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3223
Mailing Address - Country:US
Mailing Address - Phone:419-698-8570
Mailing Address - Fax:419-698-8570
Practice Address - Street 1:2702 NAVARRE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3223
Practice Address - Country:US
Practice Address - Phone:419-698-8570
Practice Address - Fax:419-698-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 038070207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2296064Medicaid
OHRE9319731Medicare ID - Type Unspecified