Provider Demographics
NPI: | 1669442950 |
---|---|
Name: | SOUTH DAYTON ACUTE CARE CONSULTANTS, INC |
Entity Type: | Organization |
Organization Name: | SOUTH DAYTON ACUTE CARE CONSULTANTS, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRACTICE ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | REBECCA |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | KRONAUGE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 937-433-8990 |
Mailing Address - Street 1: | 33 W RAHN RD |
Mailing Address - Street 2: | |
Mailing Address - City: | DAYTON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45429-2219 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 937-433-8990 |
Mailing Address - Fax: | 937-433-8691 |
Practice Address - Street 1: | 33 W RAHN RD |
Practice Address - Street 2: | |
Practice Address - City: | DAYTON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45429-2219 |
Practice Address - Country: | US |
Practice Address - Phone: | 937-433-8990 |
Practice Address - Fax: | 937-433-8691 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-01-26 |
Last Update Date: | 2020-05-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207P00000X, 207R00000X, 207RC0200X, 207RI0200X, 207RN0300X, 207RP1001X, 208M00000X, 363A00000X, 363AM0700X, 363L00000X, 363LA2100X | ||
OH | 34004845 | 207Q00000X |
OH | 35070085 | 207RE0101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0658168 | Medicaid | |
OH | 0658168 | Medicaid | |
OH | SO9923642 | Medicare PIN |