Organization
MONTGOMERY COUNTY COURT HOUSE
Active
Other names
Public Health-Dayton & Montgomery County-Public Health Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY A COOPER MS (HEALTH COMMISSIONER)
(937) 225-5700
Entity
Organization
Contact information
Practice address
117 S MAIN ST REIBOLD BUILDING 3RD FLOOR, DAYTON, OH 45422
(937) 225-4550
(937) 496-7613
Mailing address
117 S MAIN ST, FSO - SECOND FLOOR, DAYTON, OH 45422-2005
(937) 225-4543
(937) 496-3318
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000021423
ANTHEM
OH
01
—
0013149
MOLINA
OH
05
—
0013149
—
OH
01
—
01-22533
UNITED HEALTHCARE
OH
01
—
276564558011
MEDICAL MUTUAL OF OHIO
OH
Enumeration date
12/12/2006
Last updated
07/27/2018
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