Provider Demographics
NPI:1255481123
Name:DAN KEECH MD PA
Entity Type:Organization
Organization Name:DAN KEECH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:KEECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-675-2222
Mailing Address - Street 1:1701 S PALESTINE ST STE B
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-8951
Mailing Address - Country:US
Mailing Address - Phone:903-675-2222
Mailing Address - Fax:903-675-1838
Practice Address - Street 1:1701 S PALESTINE ST STE B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-8951
Practice Address - Country:US
Practice Address - Phone:903-675-2222
Practice Address - Fax:903-675-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160519801Medicaid
TX160519801OtherTPI
TX160519801OtherTPI