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Contact Information

KETTERING MEDICAL CENTER
825 N MAIN ST
SPRINGBORO, OH45066-2100
 Phone: 937-762-5090
 Fax: 937-762-5091
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Clinic Pharmacy

3336C0002X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for KETTERING MEDICAL CENTER

NPI Number 1487016796
LBN Legal business name KETTERING MEDICAL CENTER
Authorized official KEVIN BLACKBURN - (DIRECTOR OF PHARMACY)
Entity Organization
Organization subpart 1 No
Enumeration date 03/25/2016
Last updated 02/28/2017 - About 9 years ago
Identifiers
OH License # PMY.022604450-03
OH Medicaid 0171911
Other 2158450 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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