Provider Demographics
NPI:1548232754
Name:KETTINGER, JAMES JUDE (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JUDE
Last Name:KETTINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E RIVERVIEW AVE
Mailing Address - Street 2:HENRY COUNTY HOSPITAL, INC.
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9805
Mailing Address - Country:US
Mailing Address - Phone:419-591-3800
Mailing Address - Fax:419-591-3846
Practice Address - Street 1:1600 E RIVERVIEW AVE
Practice Address - Street 2:HENRY COUNTY HOSPITAL, INC.
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9805
Practice Address - Country:US
Practice Address - Phone:419-591-3800
Practice Address - Fax:419-591-3846
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.052390207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0599599Medicaid
OH0720873Medicare PIN
OHA32828Medicare UPIN
OH0599599Medicaid