1700916020 NPI number — PULMONARY MEDICINE OF DAYTON, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700916020 NPI number — PULMONARY MEDICINE OF DAYTON, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMONARY MEDICINE OF 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:
1700916020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 933242
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44193-0035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-439-3600
Provider Business Mailing Address Fax Number:
937-439-3786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 SOUTHERN BLVD
Provider Second Line Business Practice Location Address:
SLEEP LAB
Provider Business Practice Location Address City Name:
KETTERING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-439-3600
Provider Business Practice Location Address Fax Number:
937-439-3786
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADCOCK
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
937-439-3600

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0293507 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0958629 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com