Provider Demographics
NPI:1992714018
Name:DAYTON ONCOLOGY & HEMATOLOGY, PA
Entity type:Organization
Organization Name:DAYTON ONCOLOGY & HEMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RHONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-293-1622
Mailing Address - Street 1:3120 GOVERNORS PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1328
Mailing Address - Country:US
Mailing Address - Phone:937-293-1622
Mailing Address - Fax:937-299-2603
Practice Address - Street 1:3120 GOVERNORS PLACE BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45409-1328
Practice Address - Country:US
Practice Address - Phone:937-293-1622
Practice Address - Fax:937-299-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
OH207RH0003X, 2085R0001X
OH34.004894G207RH0003X
OH35.065485C207RH0003X
OH35.083711207RH0003X
OH35.07493207RH0003X
OH35.088803207RH0003X
OH34.006968207RH0003X
OH35.057684R207RH0003X
OH35.061874S207RH0003X
OH35.0506042085R0001X
OH35.047778D2085R0001X
OH0213630503336C0002X
OH2.1363053336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No3336C0002XSuppliersPharmacyClinic PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH24222266Medicaid
OH0763259Medicaid
OH0763259Medicaid
OH24222266Medicaid
OH9295791Medicare PIN
OHF55958Medicare UPIN