Provider Demographics
NPI:1952386351
Name:LUCAS COUNTY AUDITOR
Entity Type:Organization
Organization Name:LUCAS COUNTY AUDITOR
Other - Org Name:TOLEDO-LUCAS COUNTY HEALTH DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:PONGTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-213-4049
Mailing Address - Street 1:635 N ERIE ST
Mailing Address - Street 2:RM. 272
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-5317
Mailing Address - Country:US
Mailing Address - Phone:419-213-4049
Mailing Address - Fax:419-213-4017
Practice Address - Street 1:635 N ERIE ST
Practice Address - Street 2:RM. 272
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5317
Practice Address - Country:US
Practice Address - Phone:419-213-4049
Practice Address - Fax:419-213-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0844564Medicaid