Provider Demographics
NPI:1831224740
Name:SCOTT KEFFER INC
Entity type:Organization
Organization Name:SCOTT KEFFER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-228-6809
Mailing Address - Street 1:PO BOX A
Mailing Address - Street 2:
Mailing Address - City:ANSTED
Mailing Address - State:WV
Mailing Address - Zip Code:25812-1401
Mailing Address - Country:US
Mailing Address - Phone:855-250-3054
Mailing Address - Fax:304-658-4690
Practice Address - Street 1:123 JAMES RIVER & KANAWHA TURNPIKE EAST
Practice Address - Street 2:
Practice Address - City:ANSTED
Practice Address - State:WV
Practice Address - Zip Code:25812-1401
Practice Address - Country:US
Practice Address - Phone:855-250-3054
Practice Address - Fax:304-658-4690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT KEFFER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-22
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018985Medicaid
WV9366872Medicare PIN
WV3810018985Medicaid