Provider Demographics
NPI:1790233195
Name:KETTERING MEDICAL CENTER
Entity Type:Organization
Organization Name:KETTERING MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-395-8863
Mailing Address - Street 1:524 GRANTS TRAIL
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-367-7317
Mailing Address - Fax:
Practice Address - Street 1:524 GRANTS TRL
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3120
Practice Address - Country:US
Practice Address - Phone:937-367-7317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN270267282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital