Provider Demographics
NPI:1467090670
Name:KETTERING MEDICAL CENTER
Entity Type:Organization
Organization Name:KETTERING MEDICAL CENTER
Other - Org Name:KETTERING HEALTH NETWORK PREBLE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-762-1644
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3598
Mailing Address - Country:US
Mailing Address - Phone:937-384-4506
Mailing Address - Fax:937-522-7685
Practice Address - Street 1:450B WASHINGTON JACKSON RD STE 104
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7601
Practice Address - Country:US
Practice Address - Phone:937-456-8340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KETTERING MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-18
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health