1730293572 NPI number — KETTERING MEDICAL CENTER

Table of content: (NPI 1730293572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730293572 NPI number — KETTERING MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KETTERING MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KETTERING REPRODUCTIVE MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730293572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2110 LEITER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMISBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45342-3660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-298-3399
Provider Business Mailing Address Fax Number:
937-522-7685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3533 SOUTHERN BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 4100
Provider Business Practice Location Address City Name:
KETTERING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45429-1298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-395-8444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATTEN
Authorized Official First Name:
CLIFTON
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
937-395-8992

Provider Taxonomy Codes

  • Taxonomy code: 261QA0006X , with the licence number:  1017 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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