Basic Information
| Provider Information | |||||||||
| NPI: | 1093048225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE TOLEDO HOSPITAL | ||||||||
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| OtherOrganizationName: | COMMUNITY HEALTH AND WELLNESS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7140 PORT SYLVANIA DR STE 600 | ||||||||
| Address2: | #600 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198438178 | ||||||||
| FaxNumber: | 4198438698 | ||||||||
| Practice Location | |||||||||
| Address1: | 3909 WOODLEY RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436061169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192915826 | ||||||||
| FaxNumber: | 4192916492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2009 | ||||||||
| LastUpdateDate: | 09/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | MCCUNE | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 4198438178 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE TOLEDO HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.