Provider Demographics
NPI:1598524563
Name:BLACKBIRD CLINICAL SERVICES PC
Entity Type:Organization
Organization Name:BLACKBIRD CLINICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-527-6496
Mailing Address - Street 1:1247 S CEDAR CREST BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6347
Mailing Address - Country:US
Mailing Address - Phone:484-202-0751
Mailing Address - Fax:610-770-1805
Practice Address - Street 1:1247 S CEDAR CREST BLVD STE 107
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6347
Practice Address - Country:US
Practice Address - Phone:484-202-0751
Practice Address - Fax:610-770-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty