Provider Demographics
NPI:1609866722
Name:KEITH M RAMSEY MEDICAL CORP
Entity Type:Organization
Organization Name:KEITH M RAMSEY MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-503-1132
Mailing Address - Street 1:1512 BURR ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46406-2369
Mailing Address - Country:US
Mailing Address - Phone:219-944-3933
Mailing Address - Fax:219-944-2473
Practice Address - Street 1:7863 BROADWAY STE 244
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5553
Practice Address - Country:US
Practice Address - Phone:773-991-3602
Practice Address - Fax:219-962-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036485207V00000X
IL036068254207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100201350AMedicaid
D88632Medicare UPIN