Healthcare Provider Details

I. General information

NPI: 1669546081
Provider Name (Legal Business Name): DAYTON CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/07/2023
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1815
US

IV. Provider business mailing address

1 CHILDRENS PLZ
DAYTON OH
45404-1815
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-5500
  • Fax: 937-641-4451
Mailing address:
  • Phone: 937-641-5500
  • Fax: 937-641-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRIS BERGMAN
Title or Position: CFO
Credential:
Phone: 937-641-5500