Healthcare Provider Details

I. General information

NPI: 1346461613
Provider Name (Legal Business Name): DRS GREEN AND HODGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 OLD TROY PIKE
HUBER HEIGHTS OH
45424
US

IV. Provider business mailing address

300 FOREST AVE
DAYTON OH
45405-4500
US

V. Phone/Fax

Practice location:
  • Phone: 937-222-2096
  • Fax:
Mailing address:
  • Phone: 937-222-2096
  • Fax: 937-222-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number34005569
License Number StateOH

VIII. Authorized Official

Name: DR. DARIN L GREEN
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 937-222-2096