Healthcare Provider Details

I. General information

NPI: 1457382640
Provider Name (Legal Business Name): MIAMI VALLEY HEART & LUNG SURGEONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST SUITE 6252
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST SUITE 6252
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6060
  • Fax: 937-208-6061
Mailing address:
  • Phone: 937-208-6060
  • Fax: 937-208-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK P ANSTADT
Title or Position: PRESIDENT
Credential: MD
Phone: 937-208-6060