Healthcare Provider Details

I. General information

NPI: 1831224740
Provider Name (Legal Business Name): SCOTT KEFFER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 JAMES RIVER & KANAWHA TURNPIKE EAST
ANSTED WV
25812-1401
US

IV. Provider business mailing address

PO BOX A
ANSTED WV
25812-1401
US

V. Phone/Fax

Practice location:
  • Phone: 855-250-3054
  • Fax: 304-658-4690
Mailing address:
  • Phone: 855-250-3054
  • Fax: 304-658-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1615
License Number StateWV

VIII. Authorized Official

Name: SCOTT KEFFER
Title or Position: PRESIDENT
Credential: DO
Phone: 304-228-6809