Healthcare Provider Details

I. General information

NPI: 1003982307
Provider Name (Legal Business Name): KEYSTONE WHOLESALE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7328 MAPLE STREET
OMAHA NE
68134-6829
US

IV. Provider business mailing address

7328 MAPLE STREET
OMAHA NE
68134-6829
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-2659
  • Fax: 402-391-0038
Mailing address:
  • Phone: 402-391-2659
  • Fax: 402-391-0038

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. MANNY GOLDBERG
Title or Position: PRESIDENT
Credential: R.P.
Phone: 402-391-2659