Provider Demographics
NPI:1740944073
Name:KEANE, MARGARET ANN (CSFA-CST)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:KEANE
Suffix:
Gender:F
Credentials:CSFA-CST
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:GEMALSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215-0365
Mailing Address - Country:US
Mailing Address - Phone:517-281-4657
Mailing Address - Fax:
Practice Address - Street 1:6001 E WOODMEN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2601
Practice Address - Country:US
Practice Address - Phone:719-571-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA.0002729246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty