Healthcare Provider Details

I. General information

NPI: 1508848342
Provider Name (Legal Business Name): TOLEDO JOINT REPLACEMENT AND ORTHOPAEDIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 N HOLLAND SYLVANIA RD SUITE 100
TOLEDO OH
43623-3536
US

IV. Provider business mailing address

4126 N HOLLAND SYLVANIA RD SUITE 100
TOLEDO OH
43623-3536
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-5633
  • Fax: 419-843-5670
Mailing address:
  • Phone: 419-843-5633
  • Fax: 419-843-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35-055589
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number35-055589
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SCOTT W. SIVERHUS
Title or Position: PRESIDENT OWNER
Credential: M.D.
Phone: 419-843-5633