1134188410 NPI number — BARBARA ALLEN KEELER

Table of content: BARBARA ALLEN KEELER (NPI 1134188410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134188410 NPI number — BARBARA ALLEN KEELER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEELER
Provider First Name:
BARBARA
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1134188410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 PLUMMER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURYPORT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01950-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-465-6585
Provider Business Mailing Address Fax Number:
978-465-9498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MERRIMAC ST
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
NEWBURYPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01950-2558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-465-6585
Provider Business Practice Location Address Fax Number:
978-465-9498
Provider Enumeration Date:
03/23/2006

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: 1041C0700X , with the licence number:  103127 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103127 . This is a "TUFTS ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 143776000 . This is a "AETNA ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 14Y001640MA01 . This is a "ANTHEM BLUE CROSS/BLUE SH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: PO2615 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1853457 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143776000 . This is a "MBH ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 550010005745 . This is a "PACIFICARE ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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