Dayton Internal Medicine, PLLC
Organization Active NPI Internal Medicine Physician · Dayton, TN
NPI 1942594841 · NPPES record last updated Jun 21, 2011
Key facts
- NPI
- 1942594841
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 002990 (GA)
- Legal business name
- DAYTON INTERNAL MEDICINE, PLLC
- Practice address
- 188 16TH Ave
Suite 107
Dayton, TN 37321-1036 - Phone
- (423) 775-6933
- Fax
- (423) 775-3372
- NPI assigned
- Jun 8, 2011
- Organization subpart
- No
Authorized official
- Name
- Hak S. Seo, M.D.
- Title
- Owner
- Phone
- (423) 775-6933
Practitioners 10
-
Hak Sok Seo, MD
-
Lindsay Michaela Hicks, APRN
-
Hayley Brewster Ruebusch, APRN
-
Katie Lee Arnold, MSN, APRN, FNP-BC
-
Jessica Leigh Cochran, PA-C
-
Megan H Nelson, PA-C
-
Kathryn Orten, PA-C
-
Alexandra Hayden Revlett, PA-C
-
Kasey Kristen Thompson, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2028004 | Dayton Internal Medicine PLLC | Certificate of waiver | Aug 7, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110809000084 | TN | Part B Supplier - Clinic/Group Practice | 6901075993 |
Receives reassigned benefits from 10 practitioners Practice locations: Dayton, TN |
National Provider Directory
Locations
188 16th Ave
Ste 107
Dayton, TN 37321
Phone (423) 775-6933
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 002990 | GA | Yes |
Addresses
Primary practice location
188 16TH Ave
Suite 107
Dayton, TN 37321-1036
Mailing address
188 16TH Ave
Suite 107
Dayton, TN 37321-1036
Phone (423) 775-6933
Other providers in Dayton, TN
- Ashley N Davis
- Barbara Lynn Davis
- Dayspring Pediatrics PLC
- Dayton Drug and Wellness LLC
- Dayton Drug and Wellness LLC
- Dayton KDC PLLC
- Dayton Medical Investors, LLC
- Dayton Pediatrics P C
- Autumn Dayton
- Dennis Vanmeter, DMD PC
All providers in Dayton, TN · Internal Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2011. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.