Healthcare Provider Details

I. General information

NPI: 1326498882
Provider Name (Legal Business Name): TY ALLEN MCGEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WAYNE AVE
DAYTON OH
45410-1122
US

IV. Provider business mailing address

600 WAYNE AVE
DAYTON OH
45410-1122
US

V. Phone/Fax

Practice location:
  • Phone: 937-496-2000
  • Fax: 937-463-2905
Mailing address:
  • Phone: 937-496-2000
  • Fax: 937-463-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN404037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: