=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184698458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEPHROLOGY ASSOCIATES OF DAYTON INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2006
-----------------------------------------------------
Last Update Date | 04/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7700 WASHINGTON VILLAGE DR SUITE 230
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-438-3132
-----------------------------------------------------
Fax | 937-438-8707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7700 WASHINGTON VILLAGE DR SUIT 220
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-438-0099
-----------------------------------------------------
Fax | 937-438-0902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | JILL K COMBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-312-6550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------