Basic Information
| Provider Information | |||||||||
| NPI: | 1306874482 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARDIOTHORACIC SURGEONS FOR NW OHIO, INC. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2109 HUGHES DR STE 720 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436065110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912077 | ||||||||
| FaxNumber: | 4192912122 | ||||||||
| Practice Location | |||||||||
| Address1: | 2109 HUGHES DR STE 720 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436065110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912077 | ||||||||
| FaxNumber: | 4192912122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 10/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | STULL | ||||||||
| AuthorizedOfficialFirstName: | KATHYRN | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4192912077 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2079192 | 05 | OH | MEDICAID |