Healthcare Provider Details

I. General information

NPI: 1245342559
Provider Name (Legal Business Name): DAYTON PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 PATTERSON ROAD
DAYTON OH
45420-1522
US

IV. Provider business mailing address

1074 PATTERSON ROAD
DAYTON OH
45420-1522
US

V. Phone/Fax

Practice location:
  • Phone: 937-254-3988
  • Fax: 937-254-3988
Mailing address:
  • Phone: 937-254-3988
  • Fax: 937-254-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35093887
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number35093887
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA-13719
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35093887
License Number StateOH

VIII. Authorized Official

Name: ROBERT E WINDSOR
Title or Position: CEO/OWNER
Credential: MD
Phone: 859-252-6500