Provider Demographics
NPI:1982166047
Name:DUSTIN KELLER ENTERPRISES LLC
Entity Type:Organization
Organization Name:DUSTIN KELLER ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:TYE
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-610-8895
Mailing Address - Street 1:1547 RED BOTTOM RD.
Mailing Address - Street 2:
Mailing Address - City:BROOKNEAL
Mailing Address - State:VA
Mailing Address - Zip Code:24528
Mailing Address - Country:US
Mailing Address - Phone:434-610-8895
Mailing Address - Fax:
Practice Address - Street 1:1547 RED BOTTOM RD
Practice Address - Street 2:
Practice Address - City:BROOKNEAL
Practice Address - State:VA
Practice Address - Zip Code:24528
Practice Address - Country:US
Practice Address - Phone:434-610-8895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies