Provider Demographics
NPI:1083725568
Name:KEATHLY AND THOMAS LLC
Entity Type:Organization
Organization Name:KEATHLY AND THOMAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-554-9300
Mailing Address - Street 1:920 BLUEBONNET DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-4548
Mailing Address - Country:US
Mailing Address - Phone:972-554-9300
Mailing Address - Fax:
Practice Address - Street 1:920 BLUEBONNET DR
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-4548
Practice Address - Country:US
Practice Address - Phone:972-554-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX057102341600000X
TX8000663416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB640OtherBCBS
TXAMB488Medicare ID - Type Unspecified
TXAMB640OtherBCBS