Healthcare Provider Details

I. General information

NPI: 1063486314
Provider Name (Legal Business Name): DAYTON REGIONAL DIALYSIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 SHULL RD
HUBER HEIGHTS OH
45424-1234
US

IV. Provider business mailing address

7700 WASHINGTON VILLAGE DR SUITE 220
DAYTON OH
45459
US

V. Phone/Fax

Practice location:
  • Phone: 937-237-2000
  • Fax: 937-237-5630
Mailing address:
  • Phone: 937-438-0099
  • Fax: 937-438-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number0422DC
License Number StateOH

VIII. Authorized Official

Name: MR. MICHAEL L SOBECKI
Title or Position: CEO
Credential:
Phone: 937-312-6551