1083630834 NPI number — DAVID L. KEEDY M.D.

Table of content: MRS. JACQUELINE DONALDSON-FRANCOIS (NPI 1699286781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083630834 NPI number — DAVID L. KEEDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEEDY
Provider First Name:
DAVID
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1083630834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 936
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40743-0936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-330-7840
Provider Business Mailing Address Fax Number:
606-330-7825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40741-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-864-4040
Provider Business Practice Location Address Fax Number:
606-864-3500
Provider Enumeration Date:
07/14/2006

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: 207RI0011X , with the licence number:  26392 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 26392 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4000501 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 36000818 . This is a "ASC MEDICAID GROUP#" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64263924 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB5773 . This is a "RR MEDICARE GROUP#" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 37903705 . This is a "MEDICAID LAB GROUP#" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4000501 . This is a "MEDICARE LAB GROUP#" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 060086348 . This is a "RR MEDICARE PIN#" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: ASC 1019 . This is a "ASC MEDICARE GROUP#" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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