Healthcare Provider Details

I. General information

NPI: 1265824874
Provider Name (Legal Business Name): DAYTON PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 MIAMI VALLEY DR SUITE 500
CENTERVILLE OH
45459-4778
US

IV. Provider business mailing address

6680 POE AVE SUITE 200
DAYTON OH
45414-2854
US

V. Phone/Fax

Practice location:
  • Phone: 937-425-0003
  • Fax: 937-280-8373
Mailing address:
  • Phone: 937-280-8400
  • Fax: 937-280-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number021911103
License Number StateOH

VIII. Authorized Official

Name: AMY C PANSTINGEL
Title or Position: CREDENTIALING SPECIALIST
Credential: CMRS
Phone: 937-280-8366