Provider Demographics
NPI:1679548739
Name:DAYTON OSTEOPATHIC HOSPITAL
Entity type:Organization
Organization Name:DAYTON OSTEOPATHIC HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAIBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-384-4836
Mailing Address - Street 1:2351 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1201
Mailing Address - Country:US
Mailing Address - Phone:937-228-0990
Mailing Address - Fax:937-228-6090
Practice Address - Street 1:2351 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1201
Practice Address - Country:US
Practice Address - Phone:937-228-0990
Practice Address - Fax:937-228-6090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2264535Medicaid
OH3601331Medicare ID - Type Unspecified