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General NPI Number Information
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NPI Number | 1750352159
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Entity Type | Organization
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Legal Business Name | MONT GREEN ANESTHESIOLOGY INC
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 707 S. EDWIN C. MOSES BLVD.
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City | DAYTON
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State | OH
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Zip | 45408-1462
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Country | US
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Telephone | 937-221-8000
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Fax | 937-221-8529
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Provider Business Mailing Address
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Address Line | 3180 KETTERING BLVD
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City | DAYTON
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State | OH
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Zip | 45439-1924
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Country | US
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Telephone | 937-297-6072
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Fax | 937-293-0969
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS D KAMINSKI
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Credential | MD
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Telephone | 937-297-6072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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