Provider Demographics
NPI:1700885696
Name:TOLEDO REGIONAL PET SCAN, LLC
Entity type:Organization
Organization Name:TOLEDO REGIONAL PET SCAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-292-9998
Mailing Address - Street 1:3733 PARK EAST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4338
Mailing Address - Country:US
Mailing Address - Phone:216-292-9998
Mailing Address - Fax:216-292-9799
Practice Address - Street 1:3442 GRANITE CIR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1160
Practice Address - Country:US
Practice Address - Phone:419-843-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1012IC2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2485798Medicaid
OH2485798Medicaid