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General NPI Number Information
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NPI Number | 1811951452
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Entity Type | Organization
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Legal Business Name | TOLEDO COMMUNITY LITHOTRIPTER CORP.
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3158 W CENTRAL AVE
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City | TOLEDO
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State | OH
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Zip | 43606-2920
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Country | US
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Telephone | 419-531-3538
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Fax | 419-531-2807
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Provider Business Mailing Address
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Address Line | 3158 W CENTRAL AVE
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City | TOLEDO
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State | OH
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Zip | 43606-2920
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Country | US
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Telephone | 419-531-3538
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Fax | 419-531-2807
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. G. MARK SEAL
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Credential | M.D.
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Telephone | 419-725-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 417
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License Number State | OH
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