NPIMap

Organization Active NPI

Consultants in Laboratory Medicine of Greater Toledo

  • Anatomic Pathology & Clinical Pathology Physician
  • Toledo, OH
National Provider Identifier
1982673372
Registry record updated May 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
CONSULTANTS IN LABORATORY MEDICINE OF GREATER TOLEDO
Practice address
2142 N Cove Blvd
Toledo, OH 43606-3895
Phone
(419) 534-3500
Fax
(419) 534-2608
NPI assigned
Mar 16, 2006
Last updated
May 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2016

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

Authorized official

Name
Michael C. Grattendick
Title
Vice President
Phone
(561) 626-5512

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU Primary

Addresses

Primary practice location

2142 N Cove Blvd
Toledo, OH 43606-3895

Mailing address

11025 Rca Center Drive
Suite 300
Palm Beach Gardens, FL 33410-4269
Phone (561) 626-5512

Other identifiers 2

IdentifierTypeStateIssuer
2574815MedicaidMI
0738474MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040607000642 OH Part B Supplier - Clinic/Group Practice 2860474459 Receives reassigned benefits from 35 practitioners
Practice locations: Fremont, OH; Toledo, OH; Sylvania, OH; Fostoria, OH; Defiance, OH; Oregon, OH
O20070831000167 MI Part B Supplier - Clinic/Group Practice 2860474459 Receives reassigned benefits from 34 practitioners
Practice locations: Adrian, MI; Coldwater, MI; Monroe, MI; Tecumseh, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 387

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 387

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463011200000",
    "number": "1982673372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11025 RCA CENTER DRIVE",
            "address_2": "SUITE 300",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104269",
            "telephone_number": "561-626-5512",
            "fax_number": "561-626-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2142 N COVE BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063895",
            "telephone_number": "419-534-3500",
            "fax_number": "419-534-2608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONSULTANTS IN LABORATORY MEDICINE OF GREATER TOLEDO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-16",
        "last_updated": "2016-05-12",
        "status": "A",
        "authorized_official_last_name": "GRATTENDICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "561-626-5512"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2574815",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0738474",
            "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 May 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.