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General NPI Number Information
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NPI Number | 1003919176
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Entity Type | Organization
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Legal Business Name | KETTERING AFFILIATED HEALTH SERVICES
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 580 LINCOLN PARK BOULEVARD, SUITE 200 KETTERING BREAST EVALUATION CENTER
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City | KETTERING
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State | OH
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Zip | 45429
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Country | US
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Telephone | 937-299-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 LEITER RD
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City | MIAMISBURG
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State | OH
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Zip | 45342-3660
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Country | US
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Telephone | 937-298-3399
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Fax | 937-522-7685
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Authorized Official
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Title or Position | KMC NETWORK CFO
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Name | MR. BRETT SPENST
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Credential |
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Telephone | 937-395-8816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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