Healthcare Provider Details

I. General information

NPI: 1750352159
Provider Name (Legal Business Name): MONT GREEN ANESTHESIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S. EDWIN C. MOSES BLVD.
DAYTON OH
45408-1462
US

IV. Provider business mailing address

3180 KETTERING BLVD
DAYTON OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-221-8000
  • Fax: 937-221-8529
Mailing address:
  • Phone: 937-297-6072
  • Fax: 937-293-0969

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

VIII. Authorized Official

Name: DOUGLAS D KAMINSKI
Title or Position: PRESIDENT
Credential: MD
Phone: 937-297-6072