Healthcare Provider Details

I. General information

NPI: 1710391297
Provider Name (Legal Business Name): TOLEDO CLINIC INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 N HOLLAND SYLVANIA RD STE 105
TOLEDO OH
43623-3536
US

IV. Provider business mailing address

4126 N HOLLAND SYLVANIA RD STE 105
TOLEDO OH
43623-3536
US

V. Phone/Fax

Practice location:
  • Phone: 419-479-5605
  • Fax: 419-473-2049
Mailing address:
  • Phone: 419-479-5605
  • Fax: 419-473-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. REX B MOWAT
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 419-479-5605