Provider Demographics
NPI:1013381250
Name:FIRST KELLER HEALTHCARE, LLC
Entity Type:Organization
Organization Name:FIRST KELLER HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDEZMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-593-4273
Mailing Address - Street 1:891 E. KELLER PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2486
Mailing Address - Country:US
Mailing Address - Phone:682-593-4273
Mailing Address - Fax:682-307-4300
Practice Address - Street 1:891 E. KELLER PKWY STE 101
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2486
Practice Address - Country:US
Practice Address - Phone:682-593-4273
Practice Address - Fax:682-307-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201843401Medicare PIN