Healthcare Provider Details

I. General information

NPI: 1235339300
Provider Name (Legal Business Name): KEEGAN ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MEADOW LN
DUDLEY MA
01571-3723
US

IV. Provider business mailing address

PO BOX 1153
WEBSTER MA
01570-4153
US

V. Phone/Fax

Practice location:
  • Phone: 508-949-6743
  • Fax: 508-949-6745
Mailing address:
  • Phone: 508-949-6743
  • Fax: 508-949-6745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA J KEEGAN
Title or Position: OWNER
Credential:
Phone: 508-949-6743