Healthcare Provider Details

I. General information

NPI: 1538220025
Provider Name (Legal Business Name): MONTGOMERY COUNTY COURT HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S MAIN ST REIBOLD BUILDING 3RD FLOOR
DAYTON OH
45422
US

IV. Provider business mailing address

117 S MAIN ST FSO - SECOND FLOOR
DAYTON OH
45422-2005
US

V. Phone/Fax

Practice location:
  • Phone: 937-225-4550
  • Fax: 937-496-7613
Mailing address:
  • Phone: 937-225-4543
  • Fax: 937-496-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY A COOPER
Title or Position: HEALTH COMMISSIONER
Credential: MS
Phone: 937-225-5700