Provider Demographics
NPI:1437219995
Name:J KEITH PRESTON MD PA
Entity Type:Organization
Organization Name:J KEITH PRESTON MD PA
Other - Org Name:REGIONAL NEUROSURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-784-7959
Mailing Address - Street 1:4015 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-5212
Mailing Address - Country:US
Mailing Address - Phone:903-784-7959
Mailing Address - Fax:903-784-7969
Practice Address - Street 1:4015 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5212
Practice Address - Country:US
Practice Address - Phone:903-784-7959
Practice Address - Fax:903-784-7969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J KEITH PRESTON MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5880207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00X132OtherMEDICARE
G36738Medicare UPIN
TXG36738Medicare UPIN
5928650001Medicare NSC
00X132Medicare PIN