Provider Demographics
NPI:1689679680
Name:TOSC, LLC
Entity Type:Organization
Organization Name:TOSC, LLC
Other - Org Name:OSC-HMHP, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-1065
Mailing Address - Street 1:6505 MARKET STREET
Mailing Address - Street 2:BUILDING B SUITE 101
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-758-1065
Mailing Address - Fax:330-965-0580
Practice Address - Street 1:6505 MARKET STREET
Practice Address - Street 2:BUILDING B, SUITE 101
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3460
Practice Address - Country:US
Practice Address - Phone:330-758-1065
Practice Address - Fax:330-965-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0701AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2455561Medicaid
OH2455561Medicaid