Basic Information
| Provider Information | |||||||||
| NPI: | 1316488224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOLEDO CLINIC INCORPORATED | ||||||||
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| OtherOrganizationName: | TOLEDO CLINIC IMAGING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4235 SECOR RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194733561 | ||||||||
| FaxNumber: | 4194720838 | ||||||||
| Practice Location | |||||||||
| Address1: | 4126 N HOLLAND SYLVANIA RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436233536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195177081 | ||||||||
| FaxNumber: | 4195179808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2017 | ||||||||
| LastUpdateDate: | 03/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | DERAMO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHEIF ADMINISTRATIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4194733561 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TOLEDO CLINIC INCORPORATED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | N | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.