Healthcare Provider Details

I. General information

NPI: 1215745054
Provider Name (Legal Business Name): TIRRELL DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MADISON AVE STE 200
TOLEDO OH
43604-1230
US

IV. Provider business mailing address

350 E 1ST AVE STE 102
COLUMBUS OH
43201-3792
US

V. Phone/Fax

Practice location:
  • Phone: 567-312-8700
  • Fax: 567-312-8793
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: