Provider Demographics
NPI:1083630834
Name:KEEDY, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:KEEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7840
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:1210 W 5TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2112
Practice Address - Country:US
Practice Address - Phone:606-864-4040
Practice Address - Fax:606-864-3500
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26392207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4000501OtherMEDICARE GROUP NUMBER
KY36000818OtherASC MEDICAID GROUP#
KY64263924Medicaid
GACB5773OtherRR MEDICARE GROUP#
KY37903705OtherMEDICAID LAB GROUP#
KY4000501OtherMEDICARE LAB GROUP#
GA060086348OtherRR MEDICARE PIN#
KYASC 1019OtherASC MEDICARE GROUP#
KY36000818OtherASC MEDICAID GROUP#
KYASC 1019OtherASC MEDICARE GROUP#