=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003080862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE TOLEDO HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2008
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4235 SECOR RD PROMEDICA URGENT CARE
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43623-4231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-720-3989
-----------------------------------------------------
Fax | 419-720-3990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5855 MONROE ST
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-824-7264
-----------------------------------------------------
Fax | 419-824-7359
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING COORDINATOR
-----------------------------------------------------
Name | LORI MCCUNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-824-7264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------