Provider Demographics
NPI:1689968927
Name:ERNEST JOHN KETTIG
Entity Type:Organization
Organization Name:ERNEST JOHN KETTIG
Other - Org Name:KETTIG MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JEFF
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-354-9400
Mailing Address - Street 1:206A TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-8724
Mailing Address - Country:US
Mailing Address - Phone:502-354-9400
Mailing Address - Fax:502-354-9401
Practice Address - Street 1:206A TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-8724
Practice Address - Country:US
Practice Address - Phone:502-354-9400
Practice Address - Fax:502-354-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies