Provider Demographics
NPI:1114112943
Name:BANKES, KEITH G
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:G
Last Name:BANKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3361 STATE ROUTE 487
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:PA
Mailing Address - Zip Code:17878-9300
Mailing Address - Country:US
Mailing Address - Phone:570-925-2724
Mailing Address - Fax:570-925-5524
Practice Address - Street 1:3361 STATE ROUTE 487
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:PA
Practice Address - Zip Code:17878-9300
Practice Address - Country:US
Practice Address - Phone:570-925-2724
Practice Address - Fax:570-925-5524
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies