Healthcare Provider Details

I. General information

NPI: 1619285160
Provider Name (Legal Business Name): COMMUNITY MEDICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 N. MAIN STREET ST 60
DAYTON OH
45415-3153
US

IV. Provider business mailing address

9145 N DIXIE DR
DAYTON OH
45414-1859
US

V. Phone/Fax

Practice location:
  • Phone: 937-426-9500
  • Fax: 855-482-2337
Mailing address:
  • Phone: 937-426-9500
  • Fax: 855-482-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateOH

VIII. Authorized Official

Name: MISS BELINDA M CHAN
Title or Position: OWNER
Credential:
Phone: 937-322-7607