Healthcare Provider Details

I. General information

NPI: 1477968055
Provider Name (Legal Business Name): OHIO OUTPATIENT SERVICES, INC., A PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LYONS RD SUITE A
DAYTON OH
45458-1882
US

IV. Provider business mailing address

13737 NOEL RD SUITE 1200
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-9100
  • Fax:
Mailing address:
  • Phone: 214-712-2415
  • Fax: 877-614-6192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. GREG BYRNE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-712-2815