Provider Demographics
NPI:1265485759
Name:K-S NUCLEAR INC
Entity Type:Organization
Organization Name:K-S NUCLEAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANTIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-296-7211
Mailing Address - Street 1:PO BOX 292796
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-8796
Mailing Address - Country:US
Mailing Address - Phone:614-430-5726
Mailing Address - Fax:
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-296-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000009800OtherANTHEM
OH0522778Medicaid
CC4643OtherMEDICARE RAILROAD
000000009800OtherANTHEM
CC4643OtherMEDICARE RAILROAD