Provider Demographics
NPI:1760662217
Name:TOLEDO INTERNAL MEDICAL SPECIALISTS, INC.
Entity Type:Organization
Organization Name:TOLEDO INTERNAL MEDICAL SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD,CMD
Authorized Official - Phone:419-385-5751
Mailing Address - Street 1:5210 RENWYCK DR STE C
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-0905
Mailing Address - Country:US
Mailing Address - Phone:419-385-5751
Mailing Address - Fax:419-385-7162
Practice Address - Street 1:5210 RENWYCK DR STE C
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-0905
Practice Address - Country:US
Practice Address - Phone:419-385-5751
Practice Address - Fax:419-385-7162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067079S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2879121Medicaid
OH9328831Medicare PIN
OHF83716Medicare UPIN