Provider Demographics
NPI:1366469207
Name:DAYTON CHEST MEDICINE INC
Entity Type:Organization
Organization Name:DAYTON CHEST MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-396-1605
Mailing Address - Street 1:3080 ACKERMAN BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3555
Mailing Address - Country:US
Mailing Address - Phone:937-396-1605
Mailing Address - Fax:937-396-1607
Practice Address - Street 1:3080 ACKERMAN BLVD
Practice Address - Street 2:STE 100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3555
Practice Address - Country:US
Practice Address - Phone:937-396-1605
Practice Address - Fax:937-396-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCC3727OtherRAILROAD MEDICARE
OH9271012Medicare ID - Type UnspecifiedGREENVILLE OFFICE GROUP N
OH9271011Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER