Provider Demographics
NPI:1871788315
Name:RAMIC KETTERING, L.L.C.
Entity type:Organization
Organization Name:RAMIC KETTERING, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPPAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-472-0269
Mailing Address - Street 1:100 PARAGON DR
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1779
Mailing Address - Country:US
Mailing Address - Phone:201-573-8080
Mailing Address - Fax:201-573-4629
Practice Address - Street 1:580 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3474
Practice Address - Country:US
Practice Address - Phone:937-298-3510
Practice Address - Fax:937-298-4231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEG, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0839IC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPPLYING FOR MEDICARMedicare UPIN