Healthcare Provider Details

I. General information

NPI: 1598747560
Provider Name (Legal Business Name): DAYTON PEDIATRIC IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

IV. Provider business mailing address

PO BOX 3123
INDIANAPOLIS IN
46206-3123
US

V. Phone/Fax

Practice location:
  • Phone: 937-689-9117
  • Fax: 937-431-8562
Mailing address:
  • Phone: 800-901-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH H EY
Title or Position: PRESIDENT
Credential: MD
Phone: 937-307-1596