Healthcare Provider Details

I. General information

NPI: 1962655233
Provider Name (Legal Business Name): DAYTON CARDIOLOGY CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E STROOP RD
DAYTON OH
45429-4926
US

IV. Provider business mailing address

1126 S MAIN ST
DAYTON OH
45409-2616
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-3053
  • Fax: 937-853-0166
Mailing address:
  • Phone: 937-223-3053
  • Fax: 937-853-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHY LEARY
Title or Position: BILLING MGR
Credential:
Phone: 937-223-3053