Healthcare Provider Details

I. General information

NPI: 1427830058
Provider Name (Legal Business Name): PDI TOLEDO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 ORANGE PL STE 110
BEACHWOOD OH
44122-4438
US

IV. Provider business mailing address

3443 MEDINA RD STE 103
MEDINA OH
44256-5965
US

V. Phone/Fax

Practice location:
  • Phone: 216-282-0923
  • Fax: 216-242-1215
Mailing address:
  • Phone: 330-723-6600
  • Fax: 330-725-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACK CHAMPNEY CORNELL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 440-223-8848