Healthcare Provider Details

I. General information

NPI: 1255357497
Provider Name (Legal Business Name): DAYTON VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 WEST THIRD STREET
DAYTON OH
45428
US

IV. Provider business mailing address

4100 W 3RD ST
DAYTON OH
45428-9000
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax:
Mailing address:
  • Phone: 937-268-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberI0008528
License Number StateOH

VIII. Authorized Official

Name: MR. DENNIS MICHAEL MCKEE
Title or Position: SOCIAL WORKER
Credential: LISW
Phone: 937-268-6511