Healthcare Provider Details

I. General information

NPI: 1902826811
Provider Name (Legal Business Name): TLC DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5517 TELEGRAPH RD
TOLEDO OH
43612-3630
US

IV. Provider business mailing address

5517 TELEGRAPH RD
TOLEDO OH
43612-3630
US

V. Phone/Fax

Practice location:
  • Phone: 419-476-9729
  • Fax: 419-476-9650
Mailing address:
  • Phone: 419-476-9729
  • Fax: 419-476-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number1425472
License Number StateOH

VIII. Authorized Official

Name: MISS VANESSA GRACE DUNTON
Title or Position: C.E.O/OWNER
Credential:
Phone: 419-476-9350