Provider Demographics
NPI:1437316361
Name:PAUL J KEANE DPM
Entity Type:Organization
Organization Name:PAUL J KEANE DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-289-3338
Mailing Address - Street 1:506 S SUTHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5061
Mailing Address - Country:US
Mailing Address - Phone:704-289-3338
Mailing Address - Fax:704-283-1597
Practice Address - Street 1:506 S SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5061
Practice Address - Country:US
Practice Address - Phone:704-289-3338
Practice Address - Fax:704-283-1597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908153Medicaid
P00102841OtherMEDICARE RR
08153OtherBCBS
2700114OtherEVERCARE
P00102841OtherMEDICARE RR
NC8908153Medicaid
243054DMedicare PIN