| Kav Health Group Llc | |
|
5563 Far Hills Ave Dayton OH 45429-2225 | |
| (937) 291-3000 | |
| (937) 291-2303 |
| Full Name | Kav Health Group Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5563 Far Hills Ave, Dayton, Ohio |
| Authorized Official Name and Position | Kimberly Handegard (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9372912300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kav Health Group Llc 5563 Far Hills Ave Dayton OH 45429-2225 Ph: (937) 291-2300 | Kav Health Group Llc 5563 Far Hills Ave Dayton OH 45429-2225 Ph: (937) 291-3000 |
| NPI Number | 1891332946 |
|---|---|
| Provider Enumeration Date | 12/09/2019 |
| Last Update Date | 08/31/2023 |
| Certification Date | 08/31/2023 |
| Medicare PECOS PAC ID | 2466806864 |
|---|---|
| Medicare Enrollment ID | O20231003002051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891332946 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Peter D Fragatos |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780685164 PECOS PAC ID: 4688577588 Enrollment ID: I20040128001187 |
| Provider Name | Meagan B Bower |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184742090 PECOS PAC ID: 5597784769 Enrollment ID: I20051116000864 |
| Provider Name | Tara Sue Vangundy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295080851 PECOS PAC ID: 1052567302 Enrollment ID: I20120802000249 |
| Provider Name | Regina Lynne Engel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770636375 PECOS PAC ID: 4688635576 Enrollment ID: I20160919000851 |
| Provider Name | Misty L Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265623078 PECOS PAC ID: 0749559045 Enrollment ID: I20170629001695 |
| Provider Name | Rachael M Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740758804 PECOS PAC ID: 1557608114 Enrollment ID: I20190122000568 |
| Provider Name | Nafresha Abuaun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235783390 PECOS PAC ID: 2163829227 Enrollment ID: I20210916003235 |
| Provider Name | Katrina Connell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346728714 PECOS PAC ID: 7416309919 Enrollment ID: I20240119003939 |
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