Healthcare Provider Details

I. General information

NPI: 1093811051
Provider Name (Legal Business Name): KEITH VAN METER & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 DRINKWATER BLVD HANCOCK MEDICAL CENTER
BAY ST. LOUIS MS
39520
US

IV. Provider business mailing address

1816 INDUSTRIAL BLVD
HARVEY LA
70058
US

V. Phone/Fax

Practice location:
  • Phone: 228-467-8600
  • Fax:
Mailing address:
  • Phone: 504-366-7638
  • Fax: 504-263-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEITH VAN METER
Title or Position: MED DIRECTOR
Credential: MD
Phone: 504-366-7638