Provider Demographics
NPI:1740152735
Name:KETTERING HEALTH LEBANON HEALTH CENTER
Entity type:Organization
Organization Name:KETTERING HEALTH LEBANON HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APP
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-939-8018
Mailing Address - Street 1:1470 N BROADWAY ST STE 130
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1762
Mailing Address - Country:US
Mailing Address - Phone:513-696-1280
Mailing Address - Fax:
Practice Address - Street 1:1470 N BROADWAY ST STE 130
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1762
Practice Address - Country:US
Practice Address - Phone:513-696-1280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KETTERING HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty