Healthcare Provider Details

I. General information

NPI: 1265071724
Provider Name (Legal Business Name): KEEN SALES GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 S HIGHWAY 1651
PINE KNOT KY
42635-6102
US

IV. Provider business mailing address

5940 S HIGHWAY 1651
PINE KNOT KY
42635-6102
US

V. Phone/Fax

Practice location:
  • Phone: 423-223-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDALL TOMES
Title or Position: CO CEO
Credential:
Phone: 423-223-8000