Healthcare Provider Details

I. General information

NPI: 1932502606
Provider Name (Legal Business Name): LUCAS COUNTY AUDITOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 08/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 N ERIE ST BILLING RM. 272
TOLEDO OH
43604-5317
US

IV. Provider business mailing address

635 N ERIE ST BILLING RM. 272
TOLEDO OH
43604-5317
US

V. Phone/Fax

Practice location:
  • Phone: 419-213-4049
  • Fax: 419-213-4220
Mailing address:
  • Phone: 419-213-4049
  • Fax: 419-213-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID L GROSSMAN
Title or Position: COUNTY HEALTH COMMISSIONER
Credential: M.D.
Phone: 419-213-4049