1316923915 NPI number — DAYTON INTERVENTIONAL RADIOLOGY LLC

Table of content: (NPI 1316923915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316923915 NPI number — DAYTON INTERVENTIONAL RADIOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAYTON INTERVENTIONAL RADIOLOGY LLC
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:
Provider Other Organization Name Type Code:
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:
1316923915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 412865
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-2865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-644-8900
Provider Business Mailing Address Fax Number:
484-924-0053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3075 GOVERNORS PLACE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETTERING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45409-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-765-3113
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. VICE PRESIDENT
Authorized Official Telephone Number:
610-644-8900

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 36.003246 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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