Organization
K-S NUCLEAR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE C MANTIL MD (PRESIDENT)
(937) 296-7211
Entity
Organization
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 296-7211
Mailing address
PO BOX 292796, KETTERING, OH 45429-8796
(614) 430-5726
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000009800
ANTHEM
—
05
—
0522778
—
OH
01
—
CC4643
MEDICARE RAILROAD
—
Enumeration date
05/18/2006
Last updated
06/23/2008
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