Provider Demographics
NPI:1285634980
Name:CITY OF KETTERING
Entity Type:Organization
Organization Name:CITY OF KETTERING
Other - Org Name:KETTERING FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWIETERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-296-2489
Mailing Address - Street 1:PO BOX 78000 DEPT 781427
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-0001
Mailing Address - Country:US
Mailing Address - Phone:937-291-7850
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:2329 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1480
Practice Address - Country:US
Practice Address - Phone:937-298-2489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02032860013341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2420759Medicaid
OHP00041705OtherRAILROAD MEDICARE
OH000000301588OtherANTHEM
OHP00041705OtherRAILROAD MEDICARE