Provider Demographics
NPI:1730293572
Name:KETTERING MEDICAL CENTER
Entity Type:Organization
Organization Name:KETTERING MEDICAL CENTER
Other - Org Name:KETTERING REPRODUCTIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-395-8992
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3660
Mailing Address - Country:US
Mailing Address - Phone:937-298-3399
Mailing Address - Fax:937-522-7685
Practice Address - Street 1:3533 SOUTHERN BOULEVARD
Practice Address - Street 2:SUITE 4100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1298
Practice Address - Country:US
Practice Address - Phone:937-395-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KETTERING MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-18
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1017261QA0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility