Provider Demographics
NPI:1386963841
Name:TOEDR1 LLC
Entity type:Organization
Organization Name:TOEDR1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:520-299-9499
Mailing Address - Street 1:6516 N VIA DIVINA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-0970
Mailing Address - Country:US
Mailing Address - Phone:520-299-9499
Mailing Address - Fax:520-299-6571
Practice Address - Street 1:6548 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2117
Practice Address - Country:US
Practice Address - Phone:520-293-6000
Practice Address - Fax:520-299-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAR8108703332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTOEDROtherTRICARE
AZ700593 05Medicaid
AZ1Z1517OtherHEALTH NET
AZAZ0191700OtherBLUE CROSS BLUE SHIELD
AZAZ0191700OtherBLUE CROSS BLUE SHIELD
AZ700593 05Medicaid