Provider Demographics
| NPI: | 1114920329 |
|---|---|
| Name: | WRIGHT STATE PHYSICIANS INC |
| Entity Type: | Organization |
| Organization Name: | WRIGHT STATE PHYSICIANS INC |
| Other - Org Name: | UNIVERISTY MEDICAL SERVICES ASSOC. INC |
| Other - Org Type: | Former Legal Business Name |
| Authorized Official - Title/Position: | AUTHORIZED OFFICIAL |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | KIMBERLY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | PAUL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 937-245-7125 |
| Mailing Address - Street 1: | 725 UNIVERSITY BLVD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FAIRBORN |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45324-0000 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 937-245-7100 |
| Mailing Address - Fax: | 937-245-7999 |
| Practice Address - Street 1: | 725 UNIVERSITY BLVD |
| Practice Address - Street 2: | |
| Practice Address - City: | DAYTON |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 45435-0001 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 937-245-7100 |
| Practice Address - Fax: | 937-245-7999 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-05-23 |
| Last Update Date: | 2019-12-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207N00000X, 207Q00000X, 207QG0300X, 207R00000X, 207RE0101X, 207RI0200X, 207RR0500X, 207V00000X, 207VX0201X, 207X00000X, 208000000X, 2080P0206X, 208200000X, 208600000X | ||
| OH | 821388 | 2084N0400X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | Group - Multi-Specialty |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
| No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OH | 1205197985 | Other | SUBPART NPI DME MOB |
| OH | 0914443 | Medicaid | |
| 1427299841 | Other | NCS SUBPARTSURG ONC | |
| 3610562 | Other | MEDICARE PTAN ASC | |
| 1306087515 | Other | NCS SUBPART PLSTC SURG 6257 | |
| 1417133380 | Other | ORTHO DME SUBGROUP | |
| 1649447582 | Other | ASC SUBGROUP | |
| 0654700009 | Other | NSC SUITE 5253 | |
| 1215178421 | Other | NSC SUBPART VASC SURG | |
| 1295977254 | Other | ASC DME NPI | |
| OH | 10654700002 | Other | MEDICARE DME PTAN |
| 1316188147 | Other | SURGERY DME SUBGROUP | |
| OH | 821388 | Other | BUSINESS LICENSE |
| 1427299841 | Other | NCS SUBPARTSURG ONC | |
| 1306087515 | Other | NCS SUBPART PLSTC SURG 6257 | |
| 1215178421 | Other | NSC SUBPART VASC SURG | |
| OH | 1205197985 | Other | SUBPART NPI DME MOB |
| OH | 0654700011 | Medicare NSC | |
| 0654700008 | Medicare NSC | ||
| 0654700006 | Medicare NSC |
