Healthcare Provider Details

I. General information

NPI: 1265036842
Provider Name (Legal Business Name): DANIEL SUMMERVILLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3881 MURPHYS XING
DAYTON OH
45440-4346
US

IV. Provider business mailing address

3881 MURPHYS XING
DAYTON OH
45440-4346
US

V. Phone/Fax

Practice location:
  • Phone: 937-825-4524
  • Fax:
Mailing address:
  • Phone: 937-825-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: