1306087515 NPI number — WRIGHT STATE PHYSICIANS INC

Table of content: (NPI 1306087515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306087515 NPI number — WRIGHT STATE PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WRIGHT STATE PHYSICIANS 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:
Provider Other Organization Name Type Code:
6
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:
1306087515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 SPRINGFIELD ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45431-1261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-259-9900
Provider Business Mailing Address Fax Number:
937-259-9999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 E APPLE ST
Provider Second Line Business Practice Location Address:
SUITE 6257
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45409-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-208-3999
Provider Business Practice Location Address Fax Number:
937-208-3682
Provider Enumeration Date:
03/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
937-259-9900

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0914443 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1114920329 . This is a "PARENT LBN" identifier . This identifiers is of the category "OTHER".




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