Provider Demographics
NPI:1790432243
Name:KEYSTONE MEDICAL SERVICES OF ALABAMA, INC.
Entity Type:Organization
Organization Name:KEYSTONE MEDICAL SERVICES OF ALABAMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-795-3600
Mailing Address - Street 1:6075 POPLAR AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0114
Mailing Address - Country:US
Mailing Address - Phone:901-795-3600
Mailing Address - Fax:901-795-6060
Practice Address - Street 1:1330 HIGHWAY 231 S
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3058
Practice Address - Country:US
Practice Address - Phone:334-670-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty