Provider Demographics
NPI:1437257474
Name:TOLEDO ENT INC
Entity Type:Organization
Organization Name:TOLEDO ENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-578-7555
Mailing Address - Street 1:6005 MONCLOVA RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-578-7555
Mailing Address - Fax:419-539-6336
Practice Address - Street 1:6005 MONCLOVA RD
Practice Address - Street 2:SUITE 320
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-578-7555
Practice Address - Fax:419-539-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2646257Medicaid
OH2485832Medicaid
OH2485841Medicaid
OH2062191Medicaid
OH2167168Medicaid
OH9295641Medicare PIN
OH9295645Medicare PIN
OH2062191Medicaid
OH9295642Medicare PIN
OH9295644Medicare PIN