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Contact Information

INDEPENDENT PROVIDER
5659 TROY VILLA BLVD
DAYTON, OH45424-2645
 Phone: 979-451-3843
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Preferred Provider Organization

305R00000X
Indicates primary specialty

NPI Profile & details for INDEPENDENT PROVIDER

NPI Number 1699178723
LBN Legal business name INDEPENDENT PROVIDER
Authorized official LA'TASHA LEE - (INDEPENDENT PROVIDER)
Entity Organization
Organization subpart 1 No
Enumeration date 10/03/2014
Last updated 10/03/2014 - About 12 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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