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1225192610

NPI Code Detail

MEDICARE: DAYTON CHILDREN'S SPECIALTY PHYSICIANS, INC.

MEDICARE: DAYTON CHILDREN'S SPECIALTY PHYSICIANS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician
3	207W00000X	Ophthalmology Physician
4	363L00000X	Nurse Practitioner
5	152WP0200X	Pediatric Optometrist
6	364SP0200X	Pediatric Clinical Nurse Specialist
7	208M00000X	Hospitalist Physician
8	363LP0200X	Pediatric Nurse Practitioner
9	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
10	207ZP0213X	Pediatric Pathology Physician
11	367500000X	Certified Registered Nurse Anesthetist
12	208000000X	Pediatrics Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H557370	OTHER		MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225192610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYTON CHILDREN'S SPECIALTY PHYSICIANS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 933432
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0039
Country	:	US
Telephone Number	:	937-641-5072
Fax Number	:	937-641-6129

Provider Business Practice Location Address
First Line	:	1 CHILDRENS PLZ
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404-1815
Country	:	US
Telephone Number	:	937-641-4000
Fax Number	:	937-641-4500

Authorized Official
Title or Position	:	C.F.O.
Name	:	MR. CHRIS BERGMAN
Credential	:	CFO
Telephone Number	:	937-641-3338

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	06/10/2026

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Directions to “DAYTON CHILDREN'S SPECIALTY PHYSICIANS, INC. ” Practice Location

Language	Start Address	Practice Location

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