MEDICARE: EASTER KEITH

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1124850169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EASTER KEITH

Provider Business Mailing Address
First Line	:	885 CORMIER DR
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29154-7607
Country	:	US
Telephone Number	:	803-402-9087
Fax Number	:

Provider Business Practice Location Address
First Line	:	9005 TWO NOTCH RD STE 23
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5851
Country	:	US
Telephone Number	:	803-402-9087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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Directions to “ EASTER KEITH ” Practice Location

Language	Start Address	Practice Location

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