| |
1074 Patterson Rd Kettering OH 45420-1522 | |
(937) 258-6330 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1074 Patterson Rd, Kettering, Ohio |
Authorized Official Name and Position | Gregory Hopkins (CEO) |
Authorized Official Contact | 9375869733 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1323 W 3rd St Dayton OH 45402-6714 Ph: (937) 586-9733 | 1074 Patterson Rd Kettering OH 45420-1522 Ph: (937) 258-6330 |
NPI Number | 1134468549 |
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Provider Enumeration Date | 02/05/2013 |
Last Update Date | 12/21/2021 |
Medicare PECOS PAC ID | 7012094386 |
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Medicare Enrollment ID | O20130426000396 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134468549 | NPI | - | NPPES |
0085678 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 93.224 (Ohio) | Primary |
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