Provider Demographics
NPI:1619080256
Name:SOUTH DAYTON SURGEONS INC
Entity Type:Organization
Organization Name:SOUTH DAYTON SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-534-0330
Mailing Address - Street 1:3533 SOUTHERN BLVD.
Mailing Address - Street 2:SUITE 2250
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1264
Mailing Address - Country:US
Mailing Address - Phone:937-534-0330
Mailing Address - Fax:937-534-0340
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 2250
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1270
Practice Address - Country:US
Practice Address - Phone:937-534-0330
Practice Address - Fax:937-534-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty