Provider Demographics
NPI:1700277548
Name:KEAYS MEDICAL GROUP, PS
Entity Type:Organization
Organization Name:KEAYS MEDICAL GROUP, PS
Other - Org Name:BAYVIEW MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEAYS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:253-779-5858
Mailing Address - Street 1:4961 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2936
Mailing Address - Country:US
Mailing Address - Phone:253-779-5858
Mailing Address - Fax:253-779-5757
Practice Address - Street 1:4961 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2936
Practice Address - Country:US
Practice Address - Phone:253-779-5858
Practice Address - Fax:253-779-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 2083P0901X, 261QM0850X
WAOP000002141204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty