Basic Information
| Provider Information | |||||||||
| NPI: | 1811971302 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEDICAL UNIVERSITY OF OHIO AT TOLEDO | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNIVERSITY OF TOLEDO MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 ARLINGTON AVE | ||||||||
| Address2: | MAILSTOP 1166 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193835315 | ||||||||
| FaxNumber: | 4193833014 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193834000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 03/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | BARBEE | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO OF UNIVERSITY OF TOLEDO MEDICAL | ||||||||
| AuthorizedOfficialTelephone: | 4193836332 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | OH | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 5616506 | 05 | OH | MEDICAID | 3409767014 | 01 | OH | CHAMPUS | OTHER |