Provider Demographics
NPI:1821435595
Name:WRIGHT STATE UNIVERSITY
Entity Type:Organization
Organization Name:WRIGHT STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:BAS
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-223-8840
Mailing Address - Street 1:627 EDWIN C. MOSES BOULEVARD
Mailing Address - Street 2:ELIZABETH PLACE, E. MEDICAL PLAZA, 1ST FLOOR
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417
Mailing Address - Country:US
Mailing Address - Phone:937-223-8840
Mailing Address - Fax:
Practice Address - Street 1:627 EDWIN C. MOSES BOULEVARD
Practice Address - Street 2:ELIZABETH PLACE, E. MEDICAL PLAZA, 1ST FLOOR
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417
Practice Address - Country:US
Practice Address - Phone:937-223-8840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital