1841274008 NPI number — LUCAS COUNTY AUDITOR

Table of content: (NPI 1841274008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841274008 NPI number — LUCAS COUNTY AUDITOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCAS COUNTY AUDITOR
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:
WESTERN LUCAS COUNTY CLINIC
Provider Other Organization Name Type Code:
5
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:
1841274008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
635 N ERIE ST
Provider Second Line Business Mailing Address:
ATTN BILLING KATHY
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-213-4049
Provider Business Mailing Address Fax Number:
419-213-4017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 OAK TERRACE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43528-8993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-213-4049
Provider Business Practice Location Address Fax Number:
419-213-4017
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PONGTANA
Authorized Official First Name:
BOB
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, ADMINISTRATIVE SERVICES
Authorized Official Telephone Number:
419-213-4049

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0262246 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10250 . This is a "PARAMOUNT PROVIDER ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 727681 . This is a "BUCKEYE PROVIDER ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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