Provider Demographics
NPI:1568839843
Name:KEB MEDICAL CONSULTANTS LLC
Entity Type:Organization
Organization Name:KEB MEDICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETRE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-862-0712
Mailing Address - Street 1:6827 W ST CATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2687
Mailing Address - Country:US
Mailing Address - Phone:480-862-0712
Mailing Address - Fax:
Practice Address - Street 1:6827 W ST CATHERINE AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2687
Practice Address - Country:US
Practice Address - Phone:480-862-0712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL20103662314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility