Healthcare Provider Details

I. General information

NPI: 1518019587
Provider Name (Legal Business Name): TOLEDO CLINIC INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 BAY PARK DR
OREGON OH
43616-4921
US

IV. Provider business mailing address

4235 SECOR RD
TOLEDO OH
43623-4231
US

V. Phone/Fax

Practice location:
  • Phone: 419-691-4235
  • Fax:
Mailing address:
  • Phone: 419-691-4235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE P SIMONSEN-MONUS
Title or Position: DIRECTOR BILLING SERVICES
Credential:
Phone: 419-473-3561