Provider Demographics
NPI:1063486314
Name:DAYTON REGIONAL DIALYSIS INC
Entity Type:Organization
Organization Name:DAYTON REGIONAL DIALYSIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOBECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-312-6551
Mailing Address - Street 1:7700 WASHINGTON VILLAGE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-438-0099
Mailing Address - Fax:937-438-0902
Practice Address - Street 1:7211 SHULL RD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1234
Practice Address - Country:US
Practice Address - Phone:937-237-2000
Practice Address - Fax:937-237-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0422DC261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0648026Medicaid
OH0648026Medicaid