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General NPI Number Information
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NPI Number | 1871484691
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Entity Type | Organization
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Legal Business Name | BAC MEDICAL LLC
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 5900 N MAIN ST STE 3
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City | DAYTON
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State | OH
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Zip | 45415-3106
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Country | US
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Telephone | 937-277-9371
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Fax | 937-277-7734
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Provider Business Mailing Address
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Address Line | 5900 N MAIN ST STE 3
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City | DAYTON
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State | OH
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Zip | 45415-3106
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Country | US
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Telephone | 937-277-9371
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Fax |
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Authorized Official
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Title or Position | OWNER / PHYSICIAN
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Name | EDWARD P CLACK
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Credential | DO
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Telephone | 937-277-9371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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