Provider Demographics
NPI:1255483038
Name:TOLEDO CLINIC INCORPORATED
Entity type:Organization
Organization Name:TOLEDO CLINIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DERAMO
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:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:517-265-0292
Mailing Address - Fax:
Practice Address - Street 1:777 KIMOLE LN
Practice Address - Street 2:SUITE 130
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1478
Practice Address - Country:US
Practice Address - Phone:517-265-0292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOLEDO CLINIC INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0282450006Medicare NSC