BEAVERTOWN CLINIC INC NPI 1902803703

NPI Information

  • NPI: 1902803703
  • Provider Name: BEAVERTOWN CLINIC INC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 36D0349842
  • Address: 3017 WILMINGTON PIKE
    KETTERING, OH
    ZIP 45429
  • Phone: (937) 294-2555

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NPI Details

BEAVERTOWN CLINIC INC is a family medicine in Kettering, OH. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BEAVERTOWN CLINIC INC NPI is 1902803703. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3017 WILMINGTON PIKE
KETTERING, OH
ZIP 45429-169
Phone: (937) 294-2555
Fax: (937) 294-3211

The provider's authorized official is Bernard J Rose .
The authorized official title is Physician and has the following contact phone number (937) 294-2555.

The CLIA number assigned to this NPI record is 36D0349842 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/7/2005 and was last updated on 2/23/2010.

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 Medicine35058825ROHIONo
2207Q00000XFamily Medicine35052219ROHIOYes

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
1A17231MEDICARE UPINOHIO
2R00698961MEDICARE ID-TYPE UNSPECIFIEDOHIODR K ROSE INDIVIDUAL PI
3R00609981MEDICAIDOHIO
4E97912MEDICARE UPINOHIO
5BE9266611MEDICARE ID-TYPE UNSPECIFIEDOHIOGROUP ID

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: 11/21/2025

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