MEDICARE: TOLEDO CLINIC INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1417460122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOLEDO CLINIC INCORPORATED

Provider Business Mailing Address
First Line	:	4235 SECOR RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623
Country	:	US
Telephone Number	:	419-473-3561
Fax Number	:

Provider Business Practice Location Address
First Line	:	6819 SPRINGVALLEY DRIVE
Second Line	:
City	:	HOLLAND
State	:	OH
Zip	:	43528-9487
Country	:	US
Telephone Number	:	419-930-5700
Fax Number	:	419-386-0957

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	MICHAEL D'ERAMO
Credential	:
Telephone Number	:	419-473-3561

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	11/16/2017

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