Healthcare Provider Details

I. General information

NPI: 1003743147
Provider Name (Legal Business Name): TODD HIXSON CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET ST
LIMA OH
45801-4602
US

IV. Provider business mailing address

205 DEMONBREUN ST APT 2410
NASHVILLE TN
37201-2356
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-3361
  • Fax:
Mailing address:
  • Phone: 843-642-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number140035
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: