Provider Demographics
NPI:1639462674
Name:TOLEDO CLINIC INCORPORATED
Entity Type:Organization
Organization Name:TOLEDO CLINIC INCORPORATED
Other - Org Name:TOLEDO CLINIC CANCER CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BILLING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIMONSEN-MONUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-473-3561
Mailing Address - Street 1:4235 SECOR RD.
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:800 STEWART ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-242-7902
Practice Address - Fax:734-242-9199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOLEDO CLINIC INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-24
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0282450004Medicare NSC
MI0N11220Medicare PIN