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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1700712676
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	:	43623-4299
Country	:	US
Telephone Number	:	419-214-4214
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 AVENIDA MANANA NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-5709
Country	:	US
Telephone Number	:	419-214-4214
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	AMBER D PENIX
Credential	:
Telephone Number	:	419-214-4214

Provider Enumeration Date	:	06/19/2026
Last Update Date	:	06/22/2026

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