Asthma and Respiratory Center of South Dayton Inc
Organization Active NPI Pulmonary Disease Physician · Centerville, OH
NPI 1508040908 · NPPES record last updated Jan 10, 2023
Key facts
- NPI
- 1508040908
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- Legal business name
- ASTHMA AND RESPIRATORY CENTER OF SOUTH DAYTON INC
- Practice address
- 8371 Yankee St
Centerville, OH 45458-1810 - Phone
- (937) 859-5864
- NPI assigned
- Dec 20, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Fred Arthur Wagshul, M.D.
- Title
- Owner/ Ceo
- Phone
- (937) 859-5864
Practitioners 4
-
Kristal Ledbetter, FNP-C
-
Denisea Karen Mount, FNP-C
-
Mazen Abdel-Hadi, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050926000012 | OH | Part B Supplier - Clinic/Group Practice | 7719911106 |
Receives reassigned benefits from 3 practitioners Practice locations: Dayton, OH |
National Provider Directory
Locations
8371 Yankee St
Dayton, OH 45458
Phone (937) 859-5864
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician |
207RP1001X | Yes |
Addresses
Primary practice location
8371 Yankee St
Centerville, OH 45458-1810
Mailing address
PO Box 636746
Cincinnati, OH 45263-0001
Phone (937) 859-5864
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2310369 | Medicaid | OH |
Other providers in Centerville, OH
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- Jamie L Ashcraft
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- Christie Lynn Astor
- Authentically Divergent Counseling LLC
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All providers in Centerville, OH · Pulmonary Disease Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.