Healthcare Provider Details

I. General information

NPI: 1275817793
Provider Name (Legal Business Name): THE DAYTON HEART CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6623 CENTERVILLE BUSINESS PKWY
CENTERVILLE OH
45459-2655
US

IV. Provider business mailing address

1530 NEEDMORE RD 3RD FLOOR
DAYTON OH
45414-3969
US

V. Phone/Fax

Practice location:
  • Phone: 937-291-6900
  • Fax:
Mailing address:
  • Phone: 937-277-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RONNY E. SHUMAKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 937-276-8506