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General NPI Number Information
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NPI Number | 1780360297
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Entity Type | Organization
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Legal Business Name | KEYSTONE HEALTH LLC
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 508 NIOBRARA AVE
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City | HEMINGFORD
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State | NE
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Zip | 69348-9703
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Country | US
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Telephone | 308-487-5922
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95
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City | HEMINGFORD
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State | NE
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Zip | 69348-0095
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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 | AUTHORIZED OFFICIAL
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Name | DAVID RANDOLPH
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Credential |
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Telephone | 308-487-5922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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