MEDICARE: DIALYSIS CENTERS OF DAYTON, LLC

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000347247	OTHER	OH	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942281274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS CENTERS OF DAYTON, LLC

Provider Business Mailing Address
First Line	:	136 S LUDLOW ST
Second Line	:	SUITE 500
City	:	DAYTON
State	:	OH
Zip	:	45402-1813
Country	:	US
Telephone Number	:	937-499-8850
Fax Number	:	937-223-9615

Provider Business Practice Location Address
First Line	:	90 COMMERCIAL WAY
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-3080
Country	:	US
Telephone Number	:	937-499-8850
Fax Number	:	937-223-9615

Authorized Official
Title or Position	:	CONTROLLER
Name	:	JAYME NICOLE HANSEN
Credential	:
Telephone Number	:	937-499-8850

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	08/29/2012

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