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KETTERING INDEPENDENT MEDICAL GROUP INC NPI 1629387865


NPI Information

NPI: 1629387865
Provider Name: KETTERING INDEPENDENT MEDICAL GROUP INC

Former Legal Business Name: KETTERING SPECIALTY CARE, INC.

Classification: Orthopaedic Surgery - 207X00000X
Entity Type: Organization
Address:
1 PRESTIGE PL
SUITE 910
MIAMISBURG, OH
ZIP 45342
Phone: (937) 762-1629
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KETTERING INDEPENDENT MEDICAL GROUP INC is an orthopaedic surgery in Miamisburg, OH. The provider is an orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. KETTERING INDEPENDENT MEDICAL GROUP INC NPI is 1629387865. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Kettering Specialty Care, Inc..

The provider's business location address is:

1 PRESTIGE PL
SUITE 910
MIAMISBURG, OH
ZIP 45342-794
Phone: (937) 762-1629

The provider's authorized official is Timothy Y Ko .
The authorized official title is Chief Financial Officer and has the following contact phone number (937) 395-8522.

The enumeration date for this NPI number is 10/6/2010 and was last updated on 3/27/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineNo
2207R00000XInternal MedicineNo
3207RC0000XInternal MedicineCardiovascular DiseaseNo
4207V00000XObstetrics & GynecologyNo
5208600000XSurgeryNo
6207X00000XOrthopaedic SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10207472MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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