Healthcare Provider Details

I. General information

NPI: 1396177176
Provider Name (Legal Business Name): KEITH CHEEVER BUCKBEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 W AIRPORT RD
LITITZ PA
17543-9260
US

IV. Provider business mailing address

165 WEST AIRPORT ROAD
LITITZ PA
17543
US

V. Phone/Fax

Practice location:
  • Phone: 717-393-6921
  • Fax:
Mailing address:
  • Phone: 717-393-6921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF03295
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: