NPIMap

Organization Active NPI

Kathryn E. Boehm, MD, LLC

  • Clinic/Center
  • Toledo, OH
National Provider Identifier
1104052844
Registry record updated Dec 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
35056573B Issued in OH
Legal business name
KATHRYN E. BOEHM, MD, LLC
Practice address
3454 Oak Alley CT
Suite 210
Toledo, OH 43606-1306
Phone
(419) 724-6888
Fax
(419) 724-6893
NPI assigned
Jun 9, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kathryn Elaine Boehm, MD, MSNPI 1790788248
Title
Sole Proprietor
Phone
(419) 724-6888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 35056573B OH Primary

Addresses

Primary practice location

3454 Oak Alley CT
Suite 210
Toledo, OH 43606-1306

Mailing address

3454 Oak Alley CT
Suite 210
Toledo, OH 43606-1306
Phone (419) 724-6888

Other identifiers 4

IdentifierTypeStateIssuer
0744430MedicaidOH
9347012OtherMEDICARE PTAN GROUP #
KA9347011OtherOHMEDICARE PTAN GROUP #
3159862OtherOHMEDICAID GROUP NUMBER

National Provider Directory

National Provider Directory

Locations

3454 Oak Alley Ct
Ste 210
Toledo, OH 43606
Phone (419) 534-6406

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324598400000",
    "number": "1104052844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3454 OAK ALLEY CT",
            "address_2": "SUITE 210",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436061306",
            "telephone_number": "419-724-6888",
            "fax_number": "419-724-6893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3454 OAK ALLEY CT",
            "address_2": "SUITE 210",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436061306",
            "telephone_number": "419-724-6888",
            "fax_number": "419-724-6893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHRYN E. BOEHM, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-09",
        "last_updated": "2011-12-23",
        "status": "A",
        "authorized_official_last_name": "BOEHM",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "419-724-6888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MS"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OH",
            "license": "35056573B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0744430",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN GROUP #",
            "identifier": "9347012",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN GROUP #",
            "identifier": "KA9347011",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP NUMBER",
            "identifier": "3159862",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.