Provider Demographics
NPI:1780636449
Name:STORK STUDIOS, INC,
Entity Type:Organization
Organization Name:STORK STUDIOS, INC,
Other - Org Name:SYLVANIA ULTRASOUND INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:GOZDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, LPN
Authorized Official - Phone:419-841-7766
Mailing Address - Street 1:3830 WOODLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1176
Mailing Address - Country:US
Mailing Address - Phone:419-841-7766
Mailing Address - Fax:419-841-7555
Practice Address - Street 1:3830 WOODLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1176
Practice Address - Country:US
Practice Address - Phone:419-841-7766
Practice Address - Fax:419-841-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293490Medicaid
OH0293490Medicaid