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General NPI Number Information
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NPI Number | 1194724690
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Entity Type | Organization
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Legal Business Name | ENDOSCOPY CENTER OF DAYTON NORTH LLC
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 9000 N MAIN ST SUITE 405
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City | DAYTON
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State | OH
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Zip | 45415-1180
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Country | US
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Telephone | 937-320-5050
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Fax | 937-320-5060
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Provider Business Mailing Address
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Address Line | 75 SYLVANIA DR
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City | DAYTON
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State | OH
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Zip | 45440-3237
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Country | US
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Telephone | 937-320-5050
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Fax | 937-320-5060
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | CHRISTOPHER HARTSHORN
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Credential |
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Telephone | 314-800-2017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0619AS
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License Number State | OH
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