KETTERING MEDICAL CENTER (NPI# 1205005063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205005063 |
| Entity Type | Organization |
| Organization Name | KETTERING MEDICAL CENTER |
| Other Organization Name | COLLABORATIVE PHARMACY SERVICES |
| Practice Address |
4301 Lyons Rd Miamisburg OH 45342 |
| Practice Telephone | 9374584949 |
| Practice Fax Number | 9374584942 |
| Mailing Telephone | 9374584949 |
| Mailing Fax Number | 9374584942 |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2020-08-28 |
| Authorized Official Name | MR. JAMES KEVIN BLACKBURN (DIRECTOR OF PHARMACY) |
| Authorized Official Telephone | 9374584932 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | Y |
| Parent Organization Name | KETTERING MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2081107 | 01 | |
| OH | 0408149 | 05 | |
| OH | OH BOARD OF PHARMACY LIC. | 0232000177 | 01 |
| Other Name | Type Code |
|---|---|
| COLLABORATIVE PHARMACY SERVICES | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629511688 | Kettering Medical Center | Pharmacy | 3700 Southern Blvd Ste 105, Kettering, OH 45429-1226 | 2016-11-23 |
| 1790233195 | Kettering Medical Center | General Acute Care Hospital | 524 Grants Trl, Centerville, OH 45459-3120 | 2016-09-14 |
| 1790859171 | Kettering Medical Center | Pharmacy | 4000 Miamisburg-centerville Rd, Miamisburg, OH 45342 | 2006-11-20 |
| 1396346946 | Kettering Medical Center | Rehabilitation Unit | 4000 Miamisburg Centerville Rd, Miamisburg, OH 45342-7615 | 2020-11-02 |
| 1467090670 | Kettering Medical Center | Clinic/Center | 450b Washington Jackson Rd Ste 104, Eaton, OH 45320-7601 | 2019-12-18 |
| 1023587045 | Kettering Medical Center | General Acute Care Hospital | 600 W Main St, Troy, OH 45373-2928 | 2018-11-20 |
| 1487016796 | Kettering Medical Center | Pharmacy | 825 N Main St, Springboro, OH 45066-2100 | 2016-03-25 |
| 1366508657 | Kettering Medical Center | Clinic/Center | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2006-12-29 |
| 1871667253 | Kettering Medical Center | Pharmacy | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2006-11-20 |
| 1336257872 | Kettering Medical Center | Home Health | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2006-08-25 |
| Street Address |
4301 LYONS RD |
| City | MIAMISBURG |
| State | OH |
| Zip Code | 45342 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033748413 | James Kevin Blackburn | Pharmacist | 4301 Lyons Rd, Miamisburg, OH 45342-6446 | 2020-04-07 |
| 1477807642 | Heather Anne Glenn | Pharmacist | 4301 Lyons Rd, Miamisburg, OH 45342-6446 | 2012-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205464229 | Cameron Holicki | Student in an Organized Health Care Education/Training Program | Sycamore Primary Care Center 2115 Leiter Road, Miamisburg, OH 45342 | 2020-03-27 |
| 1699315663 | Heather Ann Garrett | Behavior Technician | 9260 Marketplace Drive, Miamisburg, OH 45342 | 2020-01-08 |
| 1770046443 | Makayla Rottet | Occupational Therapist | 10500 Innovation Way #320, Miamisburg, OH 45342 | 2019-04-10 |
| 1932662780 | David Chi | Student in an Organized Health Care Education/Training Program | 2115 Leiter Road, Miamisburg, OH 45342 | 2019-04-09 |
| 1508339557 | John R Striebel Dds Inc | Dentist | 9200 Marketplace Drive, Miamisburg, OH 45342 | 2019-01-02 |
| 1801382320 | Laura Maag | Nurse Practitioner | 415 Byers Rd Ste 300, Miamisburg, OH 45342 | 2018-07-09 |
| 1659862761 | Orion Sports Medicine LLC | Physical Therapist | 2042 Byers Rd, Miamisburg, OH 45342 | 2018-05-24 |
| 1982101879 | Avneek Singh Sandhu | Student in an Organized Health Care Education/Training Program | Sycamore Primary Care Center, 2115 Leiter Road, Miamisburg, OH 45342 | 2018-04-09 |
| 1700386125 | Daniel Hendricks | Nurse Practitioner | 4000 Miamisburg Centerville Rd Ste 405, Miamisburg, OH 45342 | 2018-02-13 |
| 1639692015 | Delsean Porter | Behavior Technician | 2750 Technical Dr, Miamisburg, OH 45342 | 2017-07-18 |
| Find all providers in zip 45342 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639730369 | Pharm Investco LLC | Pharmacy | 434 Alexandersville Rd, Miamisburg, OH 45342-3658 | 2019-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194323162 | East Ohio Regional Hospital | Pharmacy | 90 N 4th Street, Martins Ferry, OH 43935 | 2020-10-13 |
| 1083228852 | Harvest Grove Ltc LLC | Pharmacy | 10335 S Medallion Dr, Cincinnati, OH 45241-4825 | 2020-08-31 |
| 1801416789 | Pill Box Inc | Pharmacy | 1400 Sr 125, Amelia, OH 45102-2650 | 2020-04-21 |
| 1386271591 | Easterday Pharmacy LLC | Pharmacy | 1696 S. Arch Ave, Alliance, OH 44601 | 2020-03-26 |
| 1659911105 | Pillbox Pharmacy, LLC | Pharmacy | 324 Main St Ste B, Toledo, OH 43605-2038 | 2020-01-13 |
| 1053967364 | Ksar LLC | Pharmacy | 2245 W Dublin Granville Rd Ste 103, Worthington, OH 43085-3336 | 2019-08-13 |
| 1629639281 | Hhc Enterprises Inc | Pharmacy | 1451 Yauger Rd Ste 1h, Mount Vernon, OH 43050-7902 | 2019-06-25 |
| 1710542220 | Kratzer Pharmacy Inc. | Pharmacy | 187 W Locust St, Wilmington, OH 45177 | 2019-05-09 |
| 1760963326 | Fitzgerald Seaman Pharmacy | Pharmacy | 17860 St Rt 247, Seaman, OH 45679 | 2018-08-22 |
| 1841797073 | Pharmacy Specialty Group, LLC | Pharmacy | 6910 Treeline Dr Ste F, Brecksville, OH 44141-3366 | 2018-04-13 |
| Find all providers with the same taxonomy | ||||
| City | MIAMISBURG |
| Zip Code | 45342 |
Please comment or provide details below to improve the information on KETTERING MEDICAL CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.