Healthcare Provider Details

I. General information

NPI: 1124021324
Provider Name (Legal Business Name): DAYTON CHILDREN'S ORTHOPAEDIC CENTER FOR SPINAL & PEDIATRIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404
US

IV. Provider business mailing address

1 CHILDRENS PLZ
DAYTON OH
45404-1898
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3010
  • Fax: 937-641-5003
Mailing address:
  • Phone: 937-641-3010
  • Fax: 937-641-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number050826
License Number StateOH

VIII. Authorized Official

Name: MS. LISA COFFEY
Title or Position: PRESIDENT
Credential:
Phone: 937-641-3610