Provider Demographics
NPI:1811022619
Name:SOUTH DAYTON UROLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH DAYTON UROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-294-1489
Mailing Address - Street 1:10 SOUTHMOOR CIR NW
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2444
Mailing Address - Country:US
Mailing Address - Phone:937-294-1489
Mailing Address - Fax:937-297-6468
Practice Address - Street 1:10 SOUTHMOOR CIR NW
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2444
Practice Address - Country:US
Practice Address - Phone:937-294-1489
Practice Address - Fax:937-297-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9268341Medicare ID - Type UnspecifiedGROUPS MEDICARE NUMBER