Provider Demographics
NPI:1710391297
Name:TOLEDO CLINIC INCORPORATED
Entity Type:Organization
Organization Name:TOLEDO CLINIC INCORPORATED
Other - Org Name:TOLEDO CLINIC CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOWAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-479-5605
Mailing Address - Street 1:4126 N HOLLAND SYLVANIA RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3536
Mailing Address - Country:US
Mailing Address - Phone:419-479-5605
Mailing Address - Fax:419-473-2049
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD STE 105
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3536
Practice Address - Country:US
Practice Address - Phone:419-479-5605
Practice Address - Fax:419-473-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHB48537Medicare UPIN