Provider Demographics
NPI:1043318801
Name:UROLOGY ASSOCIATES OF DAYTON, INC.
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF DAYTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-2740
Mailing Address - Street 1:30 EAST APPLE STREET
Mailing Address - Street 2:SUITE 5258
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-2540
Mailing Address - Fax:937-208-2551
Practice Address - Street 1:30 EAST APPLE STREET
Practice Address - Street 2:SUITE 5258
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-2540
Practice Address - Fax:937-208-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0802626Medicaid
OH0802626Medicaid