Healthcare Provider Details

I. General information

NPI: 1285634980
Provider Name (Legal Business Name): CITY OF KETTERING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 HEMPSTEAD STATION DR
KETTERING OH
45429-5165
US

IV. Provider business mailing address

PO BOX 78000 DEPT 781427
DETROIT MI
48278-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-2489
  • Fax:
Mailing address:
  • Phone: 937-291-7850
  • Fax: 937-291-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number02032860013
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW GREESON
Title or Position: CITY MANAGER
Credential:
Phone: 937-296-2489