1245220458 NPI number — TOLEDO RADIATION ONCOLOGY, PLC

Table of content: (NPI 1245220458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245220458 NPI number — TOLEDO RADIATION ONCOLOGY, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOLEDO RADIATION ONCOLOGY, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
T R O PLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245220458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4841 MONROE ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43623-4385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-471-0493
Provider Business Mailing Address Fax Number:
419-472-2772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4841 MONROE ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43623-4385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-471-0493
Provider Business Practice Location Address Fax Number:
419-472-2772
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HENNING
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
419-471-0493

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH6685 . This is a "RR MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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