Healthcare Provider Details

I. General information

NPI: 1477576619
Provider Name (Legal Business Name): OHIO INSTITUTE OF CARDIAC CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 W 1ST ST
SPRINGFIELD OH
45504-1923
US

IV. Provider business mailing address

1416 W 1ST ST
SPRINGFIELD OH
45504-1923
US

V. Phone/Fax

Practice location:
  • Phone: 937-322-1700
  • Fax: 937-322-8070
Mailing address:
  • Phone: 937-322-1700
  • Fax: 937-322-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. SALIM O. DAHDAH
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 937-322-1700