Provider Demographics
NPI:1700916020
Name:PULMONARY MEDICINE OF DAYTON, INC
Entity Type:Organization
Organization Name:PULMONARY MEDICINE OF DAYTON, INC
Other - Org Name:
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 1:3535 SOUTHERN BLVD
Practice Address - Street 2:SLEEP LAB
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-439-3600
Practice Address - Fax:937-439-3786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293507Medicaid
OH0958629Medicaid
OH0293507Medicaid
OH0958629Medicaid