Healthcare Provider Details

I. General information

NPI: 1184698433
Provider Name (Legal Business Name): DAYTON REGIONAL DIALYSIS SOUTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WASHINGTON VILLAGE DR SUITE 100
DAYTON OH
45459
US

IV. Provider business mailing address

7700 WASHINGTON VILLAGE DR SUITE 220
DAYTON OH
45459
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-9595
  • Fax: 937-438-0009
Mailing address:
  • Phone: 937-438-9595
  • Fax: 937-438-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number0014DC
License Number StateOH

VIII. Authorized Official

Name: MR. MICHAEL L SOBECKI
Title or Position: CEO
Credential:
Phone: 937-438-0099