Provider Demographics
NPI:1306823638
Name:USD DAYTON, INC.
Entity Type:Organization
Organization Name:USD DAYTON, INC.
Other - Org Name:DAYTON MEDICAL IMAGING VANDALIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-675-2600
Mailing Address - Street 1:PO BOX 292921
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33687-2921
Mailing Address - Country:US
Mailing Address - Phone:813-675-2498
Mailing Address - Fax:813-971-0818
Practice Address - Street 1:113 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1934
Practice Address - Country:US
Practice Address - Phone:937-898-9729
Practice Address - Fax:937-898-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0409IC261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0787091Medicaid
OHUSID00234Medicare ID - Type Unspecified