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General NPI Number Information
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NPI Number | 1790233195
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Entity Type | Organization
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Legal Business Name | KETTERING MEDICAL CENTER
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 524 GRANTS TRL
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City | CENTERVILLE
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State | OH
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Zip | 45459-3120
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Country | US
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Telephone | 937-367-7317
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Fax |
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Provider Business Mailing Address
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Address Line | 524 GRANTS TRAIL
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City | CENTERVILLE
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State | OH
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Zip | 45459
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Country | US
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Telephone | 937-367-7317
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Fax |
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Authorized Official
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Title or Position | HR REPRESENTATIVE
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Name | JANE MALAVICH
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Credential |
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Telephone | 937-395-8863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | RN270267
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License Number State | OH
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