Provider Demographics
NPI:1265071724
Name:KEEN SALES GROUP INC
Entity type:Organization
Organization Name:KEEN SALES GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-223-8000
Mailing Address - Street 1:5940 S HIGHWAY 1651
Mailing Address - Street 2:
Mailing Address - City:PINE KNOT
Mailing Address - State:KY
Mailing Address - Zip Code:42635-6102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5940 S HIGHWAY 1651
Practice Address - Street 2:
Practice Address - City:PINE KNOT
Practice Address - State:KY
Practice Address - Zip Code:42635-6102
Practice Address - Country:US
Practice Address - Phone:423-223-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical GeneticsGroup - Multi-Specialty
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical ToxicologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0040134461Medicaid