Healthcare Provider Details

I. General information

NPI: 1104906403
Provider Name (Legal Business Name): KEENE MEDICAL PRODUCTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MAIN ST
GORHAM NH
03581-4903
US

IV. Provider business mailing address

5 LANDING RD
ENFIELD NH
03748-3545
US

V. Phone/Fax

Practice location:
  • Phone: 603-752-7694
  • Fax:
Mailing address:
  • Phone: 603-448-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. SCOTT D EASTMAN
Title or Position: SYSTEMS ADMINISTRATOR
Credential:
Phone: 603-448-5290