1033627344 NPI number — JOHN JEROME KEELING PA-C

Table of content: JOHN JEROME KEELING PA-C (NPI 1033627344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033627344 NPI number — JOHN JEROME KEELING PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEELING
Provider First Name:
JOHN
Provider Middle Name:
JEROME
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033627344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5990 S UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80121-2866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-446-5890
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5990 S UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80121-2866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-446-5890
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2018

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: 363AM0700X , with the licence number:  1338 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA.0006265 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 231771 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231792 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231146 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231029 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1764231920 . This is a "THE FEDERAL MOTOR CARRIER NATIONAL REGISTRY OF CERTIFIED MEDICAL EXAMINERS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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