Provider Demographics
NPI:1851050736
Name:PEKOSC LLC
Entity Type:Organization
Organization Name:PEKOSC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-290-3034
Mailing Address - Street 1:7634 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1526
Mailing Address - Country:US
Mailing Address - Phone:567-408-7356
Mailing Address - Fax:
Practice Address - Street 1:7634 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1526
Practice Address - Country:US
Practice Address - Phone:567-408-7356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical