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540 Lincoln Park Blvd Suite 200 Kettering OH 45429-6401 | |
| (937) 293-1117 | |
| (937) 298-4728 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 540 Lincoln Park Blvd, Kettering, Ohio |
| Authorized Official Name and Position | Mark A Couch (PRESIDENT) |
| Authorized Official Contact | 9378983600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
25 Merchant St Ste 220 - Attn Credentialing Cincinnati OH 45246-3740 Ph: (513) 533-1199 | 540 Lincoln Park Blvd Suite 200 Kettering OH 45429-6401 Ph: (937) 293-1117 |
| NPI Number | 1578521449 |
|---|---|
| Provider Enumeration Date | 05/02/2006 |
| Last Update Date | 07/15/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578521449 | NPI | - | NPPES |
| CA2478 | Other | MEDICARE RR GROUP NUMBER | |
| 3006553 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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