Provider Demographics
NPI:1699846287
Name:WRIGHT STATE UNIVERSITY DEPT OF EMERGENCY MEDICINE
Entity Type:Organization
Organization Name:WRIGHT STATE UNIVERSITY DEPT OF EMERGENCY MEDICINE
Other - Org Name:KETTERING MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:RESIDENT, EMERGENCY MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-395-8839
Mailing Address - Street 1:3881 FELICE CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2073
Mailing Address - Country:US
Mailing Address - Phone:937-431-5401
Mailing Address - Fax:
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:KETTERING MEDICAL CENTER
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-395-8839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD406102865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital