Basic Information
| Provider Information | |||||||||
| NPI: | 1801232251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAYTON CHILDREN'S MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 749 WAGON WHEEL DR | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454312714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373696764 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 CHILDRENS PLZ | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454041873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376413000 | ||||||||
| FaxNumber: | 9376415412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2013 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | MEDAUGH | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PEDIATRIC NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 9373696764 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CPNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 281PC2000X | COA14473-NP | OH | Y | Hospitals | Chronic Disease Hospital | Children |
No ID Information.