Basic Information
| Provider Information | |||||||||
| NPI: | 1497719637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNINGTON | ||||||||
| FirstName: | ROHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6880 W SNOWVILLE RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | BRECKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441413254 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2615 E HIGH ST | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 455051412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373250531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 05/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35.044797 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000017926 | 01 | OH | ANTHEM | OTHER | 0524249 | 05 | OH | MEDICAID |