Provider Demographics
NPI:1184385874
Name:TOLES PROVIDER SERVICES LLC
Entity type:Organization
Organization Name:TOLES PROVIDER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERJUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-595-9040
Mailing Address - Street 1:5319 19TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-5631
Mailing Address - Country:US
Mailing Address - Phone:239-595-9040
Mailing Address - Fax:239-330-7028
Practice Address - Street 1:5319 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-5631
Practice Address - Country:US
Practice Address - Phone:239-595-9040
Practice Address - Fax:239-330-7028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty