Healthcare Provider Details

I. General information

NPI: 1841274008
Provider Name (Legal Business Name): LUCAS COUNTY AUDITOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 OAK TERRACE BLVD
HOLLAND OH
43528-8993
US

IV. Provider business mailing address

635 N ERIE ST ATTN BILLING KATHY
TOLEDO OH
43604-1317
US

V. Phone/Fax

Practice location:
  • Phone: 419-213-4049
  • Fax: 419-213-4017
Mailing address:
  • Phone: 419-213-4049
  • Fax: 419-213-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOB PONGTANA
Title or Position: DIRECTOR, ADMINISTRATIVE SERVICES
Credential:
Phone: 419-213-4049