Provider Demographics
NPI: | 1871007567 |
---|---|
Name: | TOLEDO CLINIC INCORPORATED |
Entity Type: | Organization |
Organization Name: | TOLEDO CLINIC INCORPORATED |
Other - Org Name: | THE TOLEDO CLINIC URGENT CARE AT BRYAN |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | CHIEF ADMINISTRATIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | D'ERAMO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 419-473-3561 |
Mailing Address - Street 1: | 4235 SECOR RD |
Mailing Address - Street 2: | |
Mailing Address - City: | TOLEDO |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43623 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 419-473-3561 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 201 E HIGH ST STE 2 |
Practice Address - Street 2: | |
Practice Address - City: | BRYAN |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43506-1773 |
Practice Address - Country: | US |
Practice Address - Phone: | 419-930-5606 |
Practice Address - Fax: | 419-386-0974 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | TOLEDO CLINIC INCORPORATED |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-11-17 |
Last Update Date: | 2017-11-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |