1770572513 NPI number — WILLIAM RITCHIE KEEBLE III P.T.

Table of content: WILLIAM RITCHIE KEEBLE III P.T. (NPI 1770572513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770572513 NPI number — WILLIAM RITCHIE KEEBLE III P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEEBLE
Provider First Name:
WILLIAM
Provider Middle Name:
RITCHIE
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEEBLE
Provider Other First Name:
BILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770572513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79608-5409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-695-6011
Provider Business Mailing Address Fax Number:
325-695-4947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1665 ANTILLEY RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79606-5265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-695-6011
Provider Business Practice Location Address Fax Number:
325-695-4947
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1023539 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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