MEDICARE: DR. KEITH PATRICK STEINHURST R.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	4202	TX

General Provider Information

NPI Number	:	1821390279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH PATRICK STEINHURST R.S.

Provider Business Mailing Address
First Line	:	2050 WORTH RD, BLDG 2792, RM 312
Second Line	:	HQ USAMEDCOM (MCOP-E)
City	:	FT. SAM HOUSTON
State	:	TX
Zip	:	78234-6007
Country	:	US
Telephone Number	:	210-221-6627
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 WORTH RD, BLDG 2792, RM 312
Second Line	:	HQ USAMEDCOM (MCOP-E)
City	:	FT. SAM HOUSTON
State	:	TX
Zip	:	78234-6007
Country	:	US
Telephone Number	:	210-221-6627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	11/17/2010

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