Healthcare Provider Details

I. General information

NPI: 1215945878
Provider Name (Legal Business Name): MIDWEST PHYSICIAN SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MONROE ST STE 202
TOLEDO OH
43623
US

IV. Provider business mailing address

5151 MONROE ST STE 202
TOLEDO OH
43623
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-7787
  • Fax: 419-843-7832
Mailing address:
  • Phone: 419-843-7787
  • Fax: 419-843-7832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GEORGE B STANLEY III
Title or Position: MANAGER MIDWEST PHYSICIAN SERVICES
Credential:
Phone: 419-843-7787