Healthcare Provider Details

I. General information

NPI: 1295977254
Provider Name (Legal Business Name): WRIGHT STATE PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PHILADELPHIA DR SUITE 651
DAYTON OH
45406-1840
US

IV. Provider business mailing address

725 UNIVERSITY BLVD
DAYTON OH
45435-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3999
  • Fax: 937-208-6154
Mailing address:
  • Phone: 937-245-7100
  • Fax: 937-245-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGARET DUNN
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 937-245-7100