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General NPI Number Information
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NPI Number | 1346262813
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Entity Type | Organization
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Legal Business Name | DAYTON VA
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4351 SO. A
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City | RICHMOND
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State | IN
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Zip | 47374-6052
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Country | US
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Telephone | 765-973-6915
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Fax |
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Provider Business Mailing Address
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Address Line | 3205 CART RD
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City | RICHMOND
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State | IN
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Zip | 47374-9345
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OUTREACH COORDINATOR
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Name | MR. RAY HUGGER
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Credential |
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Telephone | 765-973-6915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 39000717A
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License Number State | IN
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