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General NPI Number Information
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NPI Number | 1083911390
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Entity Type | Organization
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Legal Business Name | KETTERING INDEPENDENT MEDICAL GROUP INC
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 4000 MIAMISBURG CENTERVILLE RD STE. 230
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City | MIAMISBURG
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State | OH
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Zip | 45342-7615
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Country | US
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Telephone | 937-384-0790
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Fax | 937-384-0794
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Provider Business Mailing Address
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Address Line | 1 PRESTIGE PL STE 550
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City | MIAMISBURG
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State | OH
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Zip | 45342-6115
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Country | US
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Telephone | 937-762-1310
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Fax | 937-522-8068
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Authorized Official
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Title or Position | CFO
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Name | TIMOTHY Y KO
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Credential |
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Telephone | 937-558-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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