Basic Information
| Provider Information | |||||||||
| NPI: | 1316116635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE TOLEDO HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5855 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198247264 | ||||||||
| FaxNumber: | 4198247359 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 W CENTRAL AVE | ||||||||
| Address2: | CENTER FOR HEALTH SERVICES INTERNAL MEDICINE | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912200 | ||||||||
| FaxNumber: | 4194793297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2008 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | MCCUNE | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 4198247264 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE TOLEDO HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8822662 | 05 | OH | MEDICAID |