=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932695012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOOFAN MEDICAL HOLDINGS, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2018
-----------------------------------------------------
Last Update Date | 07/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 CORVETTE DR STE A
-----------------------------------------------------
City | LITCHFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62056-1038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-994-9301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 AVENUE OF MID AMERICA STE 4
-----------------------------------------------------
City | EFFINGHAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62401-4634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-994-9301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAUL A TOOFAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 217-994-9301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------