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General NPI Number Information
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NPI Number | 1265071724
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Entity Type | Organization
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Legal Business Name | KEEN SALES GROUP INC
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 5940 S HIGHWAY 1651
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City | PINE KNOT
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State | KY
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Zip | 42635-6102
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Country | US
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Telephone | 423-223-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 5940 S HIGHWAY 1651
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City | PINE KNOT
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State | KY
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Zip | 42635-6102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO CEO
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Name | RANDALL TOMES
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Credential |
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Telephone | 423-223-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207SG0202X
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Taxonomy Name | Clinical Biochemical Genetics Physician
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License Number |
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License Number State |
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