Healthcare Provider Details

I. General information

NPI: 1902097280
Provider Name (Legal Business Name): DAYTON OSTEOPATHIC HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

405 W GRAND AVE
DAYTON OH
45405-4720
US

IV. Provider business mailing address

3180 KETTERING BLVD
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-3200
  • Fax:
Mailing address:
  • Phone: 937-297-6072
  • Fax: 937-293-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER J KING
Title or Position: CFO/VP
Credential:
Phone: 937-723-3414