1255481123 NPI number — DAN KEECH MD PA

Table of content: (NPI 1255481123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255481123 NPI number — DAN KEECH MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAN KEECH MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1255481123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 S PALESTINE ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75751-8951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-675-2222
Provider Business Mailing Address Fax Number:
903-675-1838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 S PALESTINE ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75751-8951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-675-2222
Provider Business Practice Location Address Fax Number:
903-675-1838
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KEECH
Authorized Official First Name:
KERRI
Authorized Official Middle Name:
MELISSA
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
903-675-2222

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 160519801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160519801 . This is a "TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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