=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396578092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOOFAN MEDICAL HOLDINGS, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2024
-----------------------------------------------------
Last Update Date | 08/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1019 CHARLESTON AVE E
-----------------------------------------------------
City | MATTOON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61938-6226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-994-9301
-----------------------------------------------------
Fax | 217-994-9304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1019 CHARLESTON AVE E
-----------------------------------------------------
City | MATTOON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61938-6226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-994-9301
-----------------------------------------------------
Fax | 217-994-9304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PAUL A TOOFAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 217-994-9301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------