Provider Demographics
NPI:1417133380
Name:WRIGHT STATE PHYSICIANS INC
Entity Type:Organization
Organization Name:WRIGHT STATE PHYSICIANS INC
Other - Org Name:WRIGHT STATE PHYSICIANS ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-245-7100
Mailing Address - Street 1:725 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45435-0001
Mailing Address - Country:US
Mailing Address - Phone:937-245-7100
Mailing Address - Fax:937-245-7999
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:STE 2200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-2091
Practice Address - Fax:937-208-6141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WRIGHT STATE PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-10
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH821388207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114920329OtherPARENT COMPANY NPI
OH0914443Medicaid
1114920329OtherPARENT COMPANY NPI
0654700002Medicare NSC