MEDICARE: DAYTON CARDIOLOGY CONSULTANTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1962655233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYTON CARDIOLOGY CONSULTANTS INC

Provider Business Mailing Address
First Line	:	1126 S MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2616
Country	:	US
Telephone Number	:	937-223-3053
Fax Number	:	937-853-0166

Provider Business Practice Location Address
First Line	:	1380 E STROOP RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-4926
Country	:	US
Telephone Number	:	937-223-3053
Fax Number	:	937-853-0166

Authorized Official
Title or Position	:	BILLING MGR
Name	:	MRS. CATHY LEARY
Credential	:
Telephone Number	:	937-223-3053

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	10/30/2008

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