Healthcare Provider Details

I. General information

NPI: 1790730638
Provider Name (Legal Business Name): DAYTON PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL STE#D
DAYTON OH
45417
US

IV. Provider business mailing address

1 ELIZABETH PL STE#D
DAYTON OH
45417-3445
US

V. Phone/Fax

Practice location:
  • Phone: 937-222-2233
  • Fax: 937-222-9665
Mailing address:
  • Phone: 937-222-2233
  • Fax: 937-222-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. BHIMAVARAPU KRISHNA REDDY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 937-222-2233