Provider Demographics
NPI:1679696314
Name:FAMILY PRACTICE ASSOCIATES OF DAYTON LLC
Entity type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF DAYTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LOVING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-451-3123
Mailing Address - Street 1:PO BOX 78000
Mailing Address - Street 2:DEPT 781267
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:45278-1267
Mailing Address - Country:US
Mailing Address - Phone:937-451-3123
Mailing Address - Fax:937-350-6477
Practice Address - Street 1:5350 LAMME RD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-3215
Practice Address - Country:US
Practice Address - Phone:937-451-3123
Practice Address - Fax:937-350-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2416675Medicaid
OHDE3261Medicare PIN
OH2416675Medicaid
OH9328961Medicare PIN