Provider Demographics
NPI:1619285160
Name:COMMUNITY MEDICAL SPECIALISTS
Entity type:Organization
Organization Name:COMMUNITY MEDICAL SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-322-7607
Mailing Address - Street 1:9145 N DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-1859
Mailing Address - Country:US
Mailing Address - Phone:937-426-9500
Mailing Address - Fax:855-482-2337
Practice Address - Street 1:7111 N. MAIN STREET ST 60
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3153
Practice Address - Country:US
Practice Address - Phone:937-426-9500
Practice Address - Fax:855-482-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0002272Medicaid