Healthcare Provider Details

I. General information

NPI: 1548690217
Provider Name (Legal Business Name): TGZ HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2013
Last Update Date: 11/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 ST LAWRENCE DR SUITE 204
TIFFIN OH
44883-8312
US

IV. Provider business mailing address

27 ST LAWRENCE DR SUITE 204
TIFFIN OH
44883-8312
US

V. Phone/Fax

Practice location:
  • Phone: 419-455-8570
  • Fax: 419-455-8579
Mailing address:
  • Phone: 419-455-8570
  • Fax: 419-455-8579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number35.121250
License Number StateOH

VIII. Authorized Official

Name: DR. THOMAS G ZACIEWSKI
Title or Position: OWNER
Credential: MD
Phone: 419-455-8570