Basic Information
| Provider Information | |||||||||
| NPI: | 1356339857 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TOLEDO PAIN SERVICES, PLL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | COMPREHENSIVE CENTERS FOR PAIN MANAGEMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 3400 MEIJER DR | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198431370 | ||||||||
| FaxNumber: | 4198431362 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 MEIJER DR | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198431370 | ||||||||
| FaxNumber: | 4198431362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JAMES | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4198431370 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 35051358 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0954712 | 05 | OH | MEDICAID | 1356339857 | 05 | MI | MEDICAID | 1497953749 | 05 | MI | MEDICAID | 1699750364 | 01 | OH | NPI JEAN PEYTON | OTHER | 1306199641 | 01 | MORROW | OTHER | 2429241 | 05 | OH | MEDICAID | 2612793 | 05 | OH | MEDICAID | 0703073 | 05 | OH | MEDICAID | 1831110048 | 01 | FRAME | OTHER | 2495698 | 05 | OH | MEDICAID | 2940509 | 05 | OH | MEDICAID | 1487734992 | 01 | HALLETT | OTHER | 1861481640 | 01 | OH | NPI -JAMES WEISS | OTHER | 2595446 | 05 | OH | MEDICAID | 1346496304 | 01 | OH | NPI | OTHER | 2741206 | 05 | OH | MEDICAID | H125931 | 01 | OH | T HALLETT PTAN-MEDICARE | OTHER | 1811089147 | 01 | SZYMANSKI | OTHER | 1083834774 | 01 | OH | NPI-CURRAN | OTHER | 1811227077 | 01 | CCHESSER | OTHER | 2568476 | 05 | OH | MEDICAID | 0055369 | 05 | OH | MEDICAID | 04525 | 01 | OH | PARAMOUNT | OTHER | 0595628 | 05 | OH | MEDICAID | 2518565 | 05 | OH | MEDICAID | 3056544 | 05 | OH | MEDICAID | BCBSM-N JENKINS | 01 | MI | 5580088 | OTHER |