Organization
LUCAS COUNTY AUDITOR
Active
Other names
WESTERN LUCAS COUNTY CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
BOB PONGTANA (DIRECTOR, ADMINISTRATIVE SERVICES)
(419) 213-4049
Entity
Organization
Contact information
Practice address
330 OAK TERRACE BLVD, HOLLAND, OH 43528-8993
(419) 213-4049
(419) 213-4017
Mailing address
635 N ERIE ST, ATTN BILLING KATHY, TOLEDO, OH 43604-1317
(419) 213-4049
(419) 213-4017
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0262246
—
OH
01
—
10250
PARAMOUNT PROVIDER ID
OH
01
—
727681
BUCKEYE PROVIDER ID
OH
Enumeration date
12/01/2005
Last updated
08/22/2020
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