MEDICARE: KEITH R. ALLEN M.D.

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	2013025450	MO

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
2	P01222589	OTHER	MO	RR MCR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	431560263	OTHER	MO	TRICARE

General Provider Information

NPI Number	:	1134186901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH R. ALLEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2580
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65801-2580
Country	:	US
Telephone Number	:	417-829-4620
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 S FREMONT AVE
Second Line	:	STE 5000
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2239
Country	:	US
Telephone Number	:	417-820-3960
Fax Number	:

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	11/08/2019

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Directions to “ KEITH R. ALLEN M.D.” Practice Location

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