Provider Demographics
NPI:1922327147
Name:MONTGOMERY COUNTY COURTHOUSE DBA PUBLIC HEALTH - DAYTON & MONTGOMERY C
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY COURTHOUSE DBA PUBLIC HEALTH - DAYTON & MONTGOMERY C
Other - Org Name:PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:937-225-4395
Mailing Address - Street 1:117 SOUTH MAIN ST.
Mailing Address - Street 2:ROOM 209, ATTN: DEBORAH PETERSON
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45422-1280
Mailing Address - Country:US
Mailing Address - Phone:937-496-3344
Mailing Address - Fax:937-496-3071
Practice Address - Street 1:1323 W 3RD ST RM 509
Practice Address - Street 2:1ST CONTACT - JENNIFER BOYD
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6714
Practice Address - Country:US
Practice Address - Phone:937-225-5878
Practice Address - Fax:937-496-3078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY COUNTY COURTHOUSE DBA PUBLIC HEALTH - DAYTON & MONTGOMERY C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLH27095065251K00000X
OH2083P0901X251K00000X
OH005826251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
005826OtherAMERICAN DIABETES ASSOCIATION