Provider Demographics
NPI:1295977254
Name:WRIGHT STATE PHYSICIANS INC
Entity type:Organization
Organization Name:WRIGHT STATE PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-245-7100
Mailing Address - Street 1:725 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45435-0001
Mailing Address - Country:US
Mailing Address - Phone:937-245-7100
Mailing Address - Fax:937-245-7999
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:SUITE 651
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1840
Practice Address - Country:US
Practice Address - Phone:937-208-3999
Practice Address - Fax:937-208-6154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WRIGHT STATE PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-06
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0914443Medicaid
1649447582OtherASC/FACILITY SUB PART NPI
OH0914443Medicaid
WR9256604Medicare PIN