Healthcare Provider Details

I. General information

NPI: 1629401898
Provider Name (Legal Business Name): DAYTON ANESTHESIA & PAIN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GRAND AVE
DAYTON OH
45405-4720
US

IV. Provider business mailing address

265 BROOKVIEW CENTRE WAY STE 203
KNOXVILLE TN
37919-4053
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-3200
  • Fax:
Mailing address:
  • Phone: 865-985-7114
  • Fax: 865-692-5867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: STACEY WILSON
Title or Position: DIRECTOR
Credential:
Phone: 865-985-7114