Provider Demographics
NPI:1275817793
Name:THE DAYTON HEART CENTER, INC.
Entity Type:Organization
Organization Name:THE DAYTON HEART CENTER, INC.
Other - Org Name:THE DAYTON HEART CENTER/SOUTH
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHUMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-276-8506
Mailing Address - Street 1:1530 NEEDMORE RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3969
Mailing Address - Country:US
Mailing Address - Phone:937-277-4274
Mailing Address - Fax:
Practice Address - Street 1:6623 CENTERVILLE BUSINESS PKWY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2655
Practice Address - Country:US
Practice Address - Phone:937-291-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DAYTON HEART CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9919881OtherMEDICARE PTAN