Provider Demographics
NPI:1457747529
Name:KEITH M KELLER
Entity Type:Organization
Organization Name:KEITH M KELLER
Other - Org Name:BREQUAN LOGISTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-662-9952
Mailing Address - Street 1:233 ANISA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:SC
Mailing Address - Zip Code:29112-8002
Mailing Address - Country:US
Mailing Address - Phone:803-662-9952
Mailing Address - Fax:
Practice Address - Street 1:233 ANISA DR
Practice Address - Street 2:
Practice Address - City:NORTH
Practice Address - State:SC
Practice Address - Zip Code:29112-8002
Practice Address - Country:US
Practice Address - Phone:803-662-9952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREQUAN LOGISTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)