Provider Demographics
NPI:1922348333
Name:GREGORY S. KELLER MD INC.
Entity Type:Organization
Organization Name:GREGORY S. KELLER MD INC.
Other - Org Name:SOUTH COAST SURGI CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-456-9932
Mailing Address - Street 1:221 W PUEBLO ST STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-6809
Mailing Address - Country:US
Mailing Address - Phone:805-563-7756
Mailing Address - Fax:805-687-0724
Practice Address - Street 1:221 W PUEBLO ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6809
Practice Address - Country:US
Practice Address - Phone:805-563-7756
Practice Address - Fax:805-687-0724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22919261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical