Healthcare Provider Details

I. General information

NPI: 1194702415
Provider Name (Legal Business Name): USD DAYTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S MAIN ST
ENGLEWOOD OH
45322-2818
US

IV. Provider business mailing address

PO BOX 292921
TAMPA FL
33687-2921
US

V. Phone/Fax

Practice location:
  • Phone: 937-836-9729
  • Fax: 937-836-5721
Mailing address:
  • Phone: 813-675-2498
  • Fax: 813-971-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number1053IC
License Number StateOH

VIII. Authorized Official

Name: GARY WRIGHT
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 813-675-2600