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General NPI Number Information
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NPI Number | 1801232251
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Entity Type | Organization
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Legal Business Name | DAYTON CHILDREN'S MEDICAL CENTER
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Dates
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Enumeration Date | 05/13/2013
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Last Update Date | 05/13/2013
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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 | 45404-1873
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Country | US
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Telephone | 937-641-3000
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Fax | 937-641-5412
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Provider Business Mailing Address
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Address Line | 749 WAGON WHEEL DR
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City | DAYTON
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State | OH
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Zip | 45431-2714
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Country | US
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Telephone | 937-369-6764
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC NURSE PRACTITIONER
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Name | MRS. ELIZABETH ANN MEDAUGH
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Credential | CPNP
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Telephone | 937-369-6764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 281PC2000X
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Taxonomy Name | Children's Chronic Disease Hospital
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License Number | COA14473-NP
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License Number State | OH
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