Provider Demographics
NPI:1376680090
Name:HEALTH SPECIALISTS OF DAYTON INC
Entity Type:Organization
Organization Name:HEALTH SPECIALISTS OF DAYTON INC
Other - Org Name:WEIGHT LOSS CENTER OF DAYTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-8252
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:SUITE 6258
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:937-208-5650
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 6258
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:937-208-5650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH SPECIALISTS OF DAYTON INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2511491Medicaid
OH2511491Medicaid