Provider Demographics
NPI:1760607154
Name:DAYTON VETERAN AFFAIRS MEDICAL CENTER
Entity Type:Organization
Organization Name:DAYTON VETERAN AFFAIRS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUCLEAR MEDICINE TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT, RT(N)
Authorized Official - Phone:937-268-6511
Mailing Address - Street 1:4939 WOODMAN PARD DR
Mailing Address - Street 2:APT 14
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 W. THIRD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHN8859799282N00000X
OH028817282N00000X
OH416313282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital