Provider Demographics
NPI:1457542722
Name:MVHE INC
Entity Type:Organization
Organization Name:MVHE INC
Other - Org Name:PREMIER EXPRESSCARE OF KETTERING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-8252
Mailing Address - Street 1:2115 E DOROTHY LN
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1176
Mailing Address - Country:US
Mailing Address - Phone:937-296-1646
Mailing Address - Fax:937-296-1647
Practice Address - Street 1:2115 E DOROTHY LN
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1176
Practice Address - Country:US
Practice Address - Phone:937-296-1646
Practice Address - Fax:937-296-1647
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MVHE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9292521Medicare PIN