Provider Demographics
NPI:1952821621
Name:KELLER, KIRK EDWIN (OWNER)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:EDWIN
Last Name:KELLER
Suffix:
Gender:M
Credentials:OWNER
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Mailing Address - Street 1:10836 120TH ST
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-9472
Mailing Address - Country:US
Mailing Address - Phone:319-523-6006
Mailing Address - Fax:319-523-2188
Practice Address - Street 1:1150 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1056
Practice Address - Country:US
Practice Address - Phone:319-523-6006
Practice Address - Fax:319-523-2188
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2023-06-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)