Provider Demographics
NPI:1679534044
Name:KEELERS MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:KEELERS MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:VETSCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:509-452-6541
Mailing Address - Street 1:2001 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2412
Mailing Address - Country:US
Mailing Address - Phone:509-452-6541
Mailing Address - Fax:509-577-7604
Practice Address - Street 1:2001 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2412
Practice Address - Country:US
Practice Address - Phone:509-452-6541
Practice Address - Fax:509-577-7604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X, 332BC3200X, 332BP3500X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9012394Medicaid
WA7009335Medicaid
WA9008699Medicaid
WA9270406Medicaid
WA0012282OtherLABOR & INDUSTRIES
WA9008699Medicaid