Organization · NPI-2

Kettering Independent Medical Group INC

Durable Medical Equipment & Medical Supplies · Beavercreek, OH

NPI number1881999449

StatusActive

Last updated in NPPESJun 13, 2023

Details

NPI: 1881999449
Entity type: Organization (NPI-2)
Legal business name: Kettering Independent Medical Group INC
Organization subpart: No
Enumeration date: Jan 12, 2011
Certification date: Jun 13, 2023
Last updated: Jun 13, 2023

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
332B00000X	Durable Medical Equipment & Medical Supplies	–	–	Yes

Practice location

3535 Pentagon Blvd
Ste. 320
Beavercreek, OH 45431-1705

Phone 937-433-5309 · Fax 937-424-3650

Mailing address

1 Prestige Pl Ste 550
Miamisburg, OH 45342-6115

Phone 937-762-1310 · Fax 937-522-8068

Authorized official

Timothy Y Ko
Cfo
9375583223

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.