1508040908 NPI number — ASTHMA AND RESPIRATORY CENTER OF SOUTH DAYTON INC

Table of content: (NPI 1508040908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508040908 NPI number — ASTHMA AND RESPIRATORY CENTER OF SOUTH DAYTON INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASTHMA AND RESPIRATORY CENTER OF SOUTH DAYTON 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:
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:
1508040908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636746
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-859-5864
Provider Business Mailing Address Fax Number:
937-859-8858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8371 YANKEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45458-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-859-5864
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WAGSHUL
Authorized Official First Name:
FRED
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
OWNER/ CEO
Authorized Official Telephone Number:
937-859-5864

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2310369 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com