Healthcare Provider Details

I. General information

NPI: 1316188147
Provider Name (Legal Business Name): WRIGHT STATE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST SUITE 5253
DAYTON OH
45409-2939
US

IV. Provider business mailing address

725 UNIVERSITY BLVD
FAIRBORN OH
45324-0000
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2552
  • Fax: 937-208-6154
Mailing address:
  • Phone: 937-245-7100
  • Fax: 937-245-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARGARET DUNN
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 937-245-7100