Provider Demographics
NPI:1205806403
Name:PULMONARY MEDICINE OF DAYTON INC.
Entity type:Organization
Organization Name:PULMONARY MEDICINE OF DAYTON INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-439-3600
Mailing Address - Street 1:PO BOX 933242
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0035
Mailing Address - Country:US
Mailing Address - Phone:937-439-3600
Mailing Address - Fax:937-439-3786
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD STE 405
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7615
Practice Address - Country:US
Practice Address - Phone:937-439-3600
Practice Address - Fax:937-741-8366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2194129Medicaid
OH2194129Medicaid
OH9253632Medicare PIN
OHH79174Medicare UPIN
OH9253632Medicare PIN
OHA80630Medicare UPIN
OHI10561Medicare UPIN
OHH52797Medicare UPIN
OHE67499Medicare UPIN
OHF91371Medicare UPIN
OHCN5673Medicare PIN
OHH96736Medicare UPIN
OHH83980Medicare UPIN
OH2194129Medicaid
OHF69085Medicare UPIN
OHH08980Medicare UPIN