Healthcare Provider Details

I. General information

NPI: 1801232251
Provider Name (Legal Business Name): DAYTON CHILDREN'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

IV. Provider business mailing address

749 WAGON WHEEL DR
DAYTON OH
45431-2714
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3000
  • Fax: 937-641-5412
Mailing address:
  • Phone: 937-369-6764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License NumberCOA14473-NP
License Number StateOH

VIII. Authorized Official

Name: MRS. ELIZABETH ANN MEDAUGH
Title or Position: PEDIATRIC NURSE PRACTITIONER
Credential: CPNP
Phone: 937-369-6764