Provider Demographics
NPI:1679752570
Name:DAYTON CARDIOLOGY CONSULT
Entity Type:Organization
Organization Name:DAYTON CARDIOLOGY CONSULT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHEDULING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-223-3053
Mailing Address - Street 1:1126 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2616
Mailing Address - Country:US
Mailing Address - Phone:937-223-3053
Mailing Address - Fax:937-853-0166
Practice Address - Street 1:2141 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2578
Practice Address - Country:US
Practice Address - Phone:937-223-3053
Practice Address - Fax:937-853-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0965871Medicaid
OHCL9186OtherRAILROAD MEDICARE
OH0965871Medicaid