Healthcare Provider Details

I. General information

NPI: 1063641272
Provider Name (Legal Business Name): DAYTON PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST
DAYTON OH
45415-1180
US

IV. Provider business mailing address

1 ELIZABETH PL STE D
DAYTON OH
45408-1445
US

V. Phone/Fax

Practice location:
  • Phone: 937-222-2233
  • Fax:
Mailing address:
  • Phone: 937-222-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35035932R
License Number StateOH

VIII. Authorized Official

Name: INDIRA REDDY
Title or Position: BUSINESS MANAGER
Credential: MD
Phone: 937-222-2233