Provider Demographics
NPI:1851554885
Name:G. KEITH CHRISTY, M.D., APMC
Entity Type:Organization
Organization Name:G. KEITH CHRISTY, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-747-4988
Mailing Address - Street 1:2400 HOSPITAL DR STE 260
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2390
Mailing Address - Country:US
Mailing Address - Phone:318-747-4988
Mailing Address - Fax:318-747-1185
Practice Address - Street 1:2400 HOSPITAL DR STE 260
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2390
Practice Address - Country:US
Practice Address - Phone:318-747-4988
Practice Address - Fax:318-747-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016819207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1354481Medicaid
LAD74790Medicare UPIN
LA1354481Medicaid