Healthcare Provider Details

I. General information

NPI: 1609061332
Provider Name (Legal Business Name): KEITH & ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 3RD ST STE 800
TULSA OK
74103-3421
US

IV. Provider business mailing address

115 W 3RD ST STE 800
TULSA OK
74103-3421
US

V. Phone/Fax

Practice location:
  • Phone: 918-585-3045
  • Fax: 918-585-3047
Mailing address:
  • Phone: 918-585-3045
  • Fax: 918-585-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number611
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: SANDRA KEITH
Title or Position: PRESIDENT
Credential: MPH RD/LD
Phone: 918-585-3045