Basic Information
| Provider Information | |||||||||
| NPI: | 1942350244 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAYTON SURGEONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ELIZABETH PL | ||||||||
| Address2: | SUITE 10A | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454173445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372284126 | ||||||||
| FaxNumber: | 9372280247 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ELIZABETH PL | ||||||||
| Address2: | SUITE 10A | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454173445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372284126 | ||||||||
| FaxNumber: | 9372280247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 05/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | HENNIGAN | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9372284126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0339495 | 05 | OH | MEDICAID |