Provider Demographics
NPI:1407489347
Name:KELLER FAMILY MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:KELLER FAMILY MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:DINGESS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-431-2573
Mailing Address - Street 1:808 KELLER PKWY
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2405
Mailing Address - Country:US
Mailing Address - Phone:817-431-2573
Mailing Address - Fax:817-379-6881
Practice Address - Street 1:808 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2405
Practice Address - Country:US
Practice Address - Phone:817-431-2573
Practice Address - Fax:817-379-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty