Kettering Integrated Services LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

KETTERING INTEGRATED SERVICES LLC

Doing business as

Renew Boutique and Spa

Practice address

3700 Southern Blvd
Kettering, OH 45429-1226

Phone

(937) 281-3855

NPI assigned

Dec 15, 2016

Last updated

Aug 2, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Timothy Ko

Title

Kettering Health Cfo

Phone

(937) 558-3223

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Renew Boutique and Spa Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1932643673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 LEITER RD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453423598",
            "telephone_number": "937-914-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SOUTHERN BLVD",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291226",
            "telephone_number": "937-281-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETTERING INTEGRATED SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-15",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "KETTERING HEALTH CFO",
        "authorized_official_telephone_number": "937-558-3223"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0234746",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renew Boutique and Spa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Renew Boutique and Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kettering Medical Center (Kettering Health Main Campus)
• Kettering Medical Center (Kettering Network HomeCare)
• Kettering Medical Center (Precious Beginnings Home Care)
• Kettering Medical Center (Kettering Reproductive Medicine)
• Kettering Medical Center (Kettering Health Pharmacy Main Campus)

• Prosthetic/Orthotic Supplier in Kettering, OH
• Providers in Kettering, OH by specialty
• Prosthetic/Orthotic Supplier in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.