Healthcare Provider Details

I. General information

NPI: 1730358169
Provider Name (Legal Business Name): J SCOTT WILCHER M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 N MAIN ST STE 60
DAYTON OH
45415-2558
US

IV. Provider business mailing address

7111 N MAIN ST STE 60
DAYTON OH
45415-2558
US

V. Phone/Fax

Practice location:
  • Phone: 937-276-3445
  • Fax: 937-276-2855
Mailing address:
  • Phone: 937-276-3445
  • Fax: 937-276-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35-061598
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35-061598
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-061598
License Number StateOH

VIII. Authorized Official

Name: DR. J SCOTT WILCHER
Title or Position: OWNER
Credential: M.D.
Phone: 937-276-3445