Provider Demographics
NPI:1508848342
Name:TOLEDO JOINT REPLACEMENT AND ORTHOPAEDIC CENTER
Entity Type:Organization
Organization Name:TOLEDO JOINT REPLACEMENT AND ORTHOPAEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIVERHUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-843-5633
Mailing Address - Street 1:4126 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3536
Mailing Address - Country:US
Mailing Address - Phone:419-843-5633
Mailing Address - Fax:419-843-5670
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3536
Practice Address - Country:US
Practice Address - Phone:419-843-5633
Practice Address - Fax:419-843-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-055589207X00000X, 207XS0114X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1187660001OtherDMERC
OHCF8096OtherRAILROAD MEDICARE
OH=========00OtherBWC
OH1187660001OtherDMERC