Provider Demographics
NPI:1558323238
Name:TOLEDO CRITICAL CARE, INC.
Entity Type:Organization
Organization Name:TOLEDO CRITICAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:BANOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-291-4800
Mailing Address - Street 1:601 WASHINGTON AVE
Mailing Address - Street 2:SUITE 390
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-1986
Mailing Address - Country:US
Mailing Address - Phone:859-291-4800
Mailing Address - Fax:859-655-8588
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2011727Medicaid
OH9281081Medicare PIN
OH2011727Medicaid