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9000 N Main St Suite 300 Dayton OH 45415-1180 | |
| (937) 832-1500 | |
| (937) 832-0662 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 9000 N Main St, Dayton, Ohio |
| Authorized Official Name and Position | Kenneth Prunier (PRESIDENT/CEO) |
| Authorized Official Contact | 9372088213 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9000 N Main St Suite 300 Dayton OH 45415-1180 Ph: (937) 832-1500 | 9000 N Main St Suite 300 Dayton OH 45415-1180 Ph: (937) 832-1500 |
| NPI Number | 1134172661 |
|---|---|
| Provider Enumeration Date | 05/18/2006 |
| Last Update Date | 11/08/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134172661 | NPI | - | NPPES |
| 2022368 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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