Provider Demographics
NPI:1437340825
Name:HEALTH SPECIALISTS OF DAYTON INC
Entity Type:Organization
Organization Name:HEALTH SPECIALISTS OF DAYTON INC
Other - Org Name:MELISSA P ROELLE MD COMPANY
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:937-208-8213
Mailing Address - Street 1:1 ELIZABETH PL
Mailing Address - Street 2:STE 10A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408-1445
Mailing Address - Country:US
Mailing Address - Phone:937-228-0248
Mailing Address - Fax:937-228-0247
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:STE 10A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1445
Practice Address - Country:US
Practice Address - Phone:937-228-0248
Practice Address - Fax:937-228-0247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH SPECIALISTS OF DAYTON INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-09
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2764512Medicaid
OH2764512Medicaid