Provider Demographics
NPI:1134334899
Name:HEALTH SPECIALISTS OF DAYTON INC
Entity type:Organization
Organization Name:HEALTH SPECIALISTS OF DAYTON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-8273
Mailing Address - Street 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5200
Mailing Address - Country:US
Mailing Address - Phone:513-420-4660
Mailing Address - Fax:513-420-4662
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 290
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-5200
Practice Address - Country:US
Practice Address - Phone:513-420-4660
Practice Address - Fax:513-420-4662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH SPECIALISTS OF DAYTON INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-14
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9360741Medicare PIN