Basic Information
| Provider Information | |||||||||
| NPI: | 1629401898 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAYTON ANESTHESIA & PAIN SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7111 FAIRWAY DR | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334184204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616232052 | ||||||||
| FaxNumber: | 8652913612 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 W GRAND AVE | ||||||||
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| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454054720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377233200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2013 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOLZCLAW | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5616232052 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.