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General NPI Number Information
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NPI Number | 1124021324
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Entity Type | Organization
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Legal Business Name | DAYTON CHILDREN'S ORTHOPAEDIC CENTER FOR SPINAL & PEDIATRIC CARE, LLC
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 1 CHILDRENS PLZ
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City | DAYTON
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State | OH
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Zip | 45404
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Country | US
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Telephone | 937-641-3010
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Fax | 937-641-5003
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Provider Business Mailing Address
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Address Line | 1 CHILDRENS PLZ
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City | DAYTON
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State | OH
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Zip | 45404-1898
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Country | US
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Telephone | 937-641-3010
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Fax | 937-641-5003
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LISA COFFEY
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Credential |
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Telephone | 937-641-3610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 050826
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License Number State | OH
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