Healthcare Provider Details

I. General information

NPI: 1700277548
Provider Name (Legal Business Name): KEAYS MEDICAL GROUP, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4961 MAIN ST STE A
TACOMA WA
98407-2936
US

IV. Provider business mailing address

4961 MAIN ST STE A
TACOMA WA
98407-2936
US

V. Phone/Fax

Practice location:
  • Phone: 253-779-5858
  • Fax: 253-779-5757
Mailing address:
  • Phone: 253-779-5858
  • Fax: 253-779-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOP000002141
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY C KEAYS
Title or Position: PRESIDENT
Credential: D.O.
Phone: 253-779-5858