Healthcare Provider Details

I. General information

NPI: 1114112943
Provider Name (Legal Business Name): KEITH G BANKES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 STATE ROUTE 487
STILLWATER PA
17878-9300
US

IV. Provider business mailing address

3361 STATE ROUTE 487
STILLWATER PA
17878-9300
US

V. Phone/Fax

Practice location:
  • Phone: 570-925-2724
  • Fax: 570-925-5524
Mailing address:
  • Phone: 570-925-2724
  • Fax: 570-925-5524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: