1285918706 NPI number — THE DAYTON HEART CENTER, INC.

Table of content: (NPI 1285918706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285918706 NPI number — THE DAYTON HEART CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DAYTON HEART CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GREENVILLE HEART CARE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285918706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 NEEDMORE RD
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45414-3969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-277-4274
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
742 SWEITZER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45331-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-547-9701
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHUMAKER
Authorized Official First Name:
RONNY
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
937-276-8506

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9919881 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".