Healthcare Provider Details

I. General information

NPI: 1225241029
Provider Name (Legal Business Name): DAYTON OCCUPATIONAL MEDICAL CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2597 NEEDMORE RD
DAYTON OH
45414-4203
US

IV. Provider business mailing address

2597 NEEDMORE RD
DAYTON OH
45414-4203
US

V. Phone/Fax

Practice location:
  • Phone: 937-277-4053
  • Fax: 937-277-2943
Mailing address:
  • Phone: 937-277-4053
  • Fax: 937-277-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35078014
License Number StateOH

VIII. Authorized Official

Name: MS. BRENDA K LEWIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 937-277-4053