Healthcare Provider Details

I. General information

NPI: 1215460357
Provider Name (Legal Business Name): THOMAS EDWARD BARBER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 WAYNE AVE BUILDING 64 UNIT 55
DAYTON OH
45420-1833
US

IV. Provider business mailing address

2611 WAYNE AVE UNIT 55
DAYTON OH
45420-1833
US

V. Phone/Fax

Practice location:
  • Phone: 937-256-7801
  • Fax: 937-259-1148
Mailing address:
  • Phone: 937-256-7801
  • Fax: 937-303-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number491728
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number491728
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: