Healthcare Provider Details

I. General information

NPI: 1376266494
Provider Name (Legal Business Name): PDI TOLEDO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 ANTENUCCI BLVD SUITE 205
GARFIELD HEIGHTS OH
44125
US

IV. Provider business mailing address

10500 ANTENUCCI BLVD SUITE 205
GARFIELD HEIGHTS OH
44125
US

V. Phone/Fax

Practice location:
  • Phone: 216-282-0923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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