MEDICARE: CITY OF KEENE TEX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	300110	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124057948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF KEENE TEX

Provider Business Mailing Address
First Line	:	100 N MOCKINGBIRD LN
Second Line	:
City	:	KEENE
State	:	TX
Zip	:	76059-2323
Country	:	US
Telephone Number	:	817-556-2474
Fax Number	:	817-645-8080

Provider Business Practice Location Address
First Line	:	203 W HILLCREST
Second Line	:
City	:	KEENE
State	:	TX
Zip	:	76059
Country	:	US
Telephone Number	:	817-648-7536
Fax Number	:	817-645-8080

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MICHELLE BEESON
Credential	:	MD
Telephone Number	:	972-339-4234

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/07/2009

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Directions to “CITY OF KEENE TEX ” Practice Location

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