1922327147 NPI number — MONTGOMERY COUNTY COURTHOUSE DBA PUBLIC HEALTH - DAYTON & MONTGOMERY C

Table of content: (NPI 1922327147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922327147 NPI number — MONTGOMERY COUNTY COURTHOUSE DBA PUBLIC HEALTH - DAYTON & MONTGOMERY C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY COUNTY COURTHOUSE DBA PUBLIC HEALTH - DAYTON & MONTGOMERY C
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:
PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY
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:
1922327147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 SOUTH MAIN ST.
Provider Second Line Business Mailing Address:
ROOM 209, ATTN: DEBORAH PETERSON
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45422-1280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-496-3344
Provider Business Mailing Address Fax Number:
937-496-3071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1323 W 3RD ST RM 509
Provider Second Line Business Practice Location Address:
1ST CONTACT - JENNIFER BOYD
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45402-6714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-225-5878
Provider Business Practice Location Address Fax Number:
937-496-3078
Provider Enumeration Date:
05/27/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GROSS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
HEALTH COMMISSIONER
Authorized Official Telephone Number:
937-225-4395

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  LH27095065 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251K00000X , with the licence number: 2083P0901X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , with the licence number: 005826 , 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)

  • Identifier: 005826 . This is a "AMERICAN DIABETES ASSOCIATION" identifier . This identifiers is of the category "OTHER".