Organization
TOLEDO COMMUNITY LITHOTRIPTER CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. G. MARK SEAL M.D. (PRESIDENT)
(419) 725-4400
Entity
Organization
Contact information
Practice address
3158 W CENTRAL AVE, TOLEDO, OH 43606-2920
(419) 531-3538
(419) 531-2807
Mailing address
3158 W CENTRAL AVE, TOLEDO, OH 43606-2920
(419) 531-3538
(419) 531-2807
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
417
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01767
PARAMOUNT
—
05
—
0986054
—
OH
01
—
156605
ANTHEM
—
01
—
2124675
AETNA
—
01
—
3610521
MMOH
—
01
—
604727
BUCKEYE COMM. HEALTH PLAN
—
Enumeration date
04/12/2006
Last updated
08/22/2020
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