Provider Demographics
NPI:1649447582
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:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAKINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-245-7150
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WRIGHT STATE PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-09
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH821388261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WR9256604OtherPARENT LBN MEDICARE GROUP NUMBER
1114920329OtherPARENT NPI
1295977254OtherDME-SUBGROUP NPI
OH0914443Medicaid
1295977254OtherDME-SUBGROUP NPI