Provider Demographics
NPI:1386829331
Name:KEENE & KEENE MD PA
Entity Type:Organization
Organization Name:KEENE & KEENE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:H
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-722-9918
Mailing Address - Street 1:PO BOX 450329
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0007
Mailing Address - Country:US
Mailing Address - Phone:956-722-9918
Mailing Address - Fax:956-722-0829
Practice Address - Street 1:6801 MCPHERSON AVE
Practice Address - Street 2:SUITE 331
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6417
Practice Address - Country:US
Practice Address - Phone:956-722-9918
Practice Address - Fax:956-722-0829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2893207K00000X, 208000000X
TXD2894207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017657002Medicaid
TX121446205Medicaid
TX089809003Medicaid
TX017657002Medicaid
8F9026Medicare PIN
00Z757Medicare PIN