Provider Demographics
NPI:1326592841
Name:KEEVER PEDIATRICS PA
Entity Type:Organization
Organization Name:KEEVER PEDIATRICS PA
Other - Org Name:OZARK PEDIATRICS PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-544-9432
Mailing Address - Street 1:5507 W WALSH LN STE 101
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9007
Mailing Address - Country:US
Mailing Address - Phone:479-544-9432
Mailing Address - Fax:479-544-9443
Practice Address - Street 1:5507 W WALSH LN STE 101
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9007
Practice Address - Country:US
Practice Address - Phone:479-544-9432
Practice Address - Fax:479-544-9443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3170261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146352001Medicaid
AR338710YJLKMedicare PIN