Basic Information
| Provider Information | |||||||||
| NPI: | 1407833759 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TOLEDO IMAGING, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TOLEDO MEDICAL IMAGING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 76626 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441016500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136752498 | ||||||||
| FaxNumber: | 8139710818 | ||||||||
| Practice Location | |||||||||
| Address1: | 5660 MONROE ST | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198823333 | ||||||||
| FaxNumber: | 4198851568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 8136752600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | 0844IC | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2297321 | 05 | OH | MEDICAID |