MEDICARE: PAUL KEANE

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	213E00000X	Podiatrist	57	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00351117	OTHER	SC	RAILROAD MEDICARE

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	:	1245355890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL KEANE

Provider Business Mailing Address
First Line	:	P O BOX 7396
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-4837
Country	:	US
Telephone Number	:	252-985-1371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 E MAIN ST
Second Line	:	STE 14, TMB 151
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-2309
Country	:	US
Telephone Number	:	252-985-1371
Fax Number	:

Authorized Official
Title or Position	:	PODIATRIST
Name	:	PAUL J KEANE
Credential	:	DPM
Telephone Number	:	252-985-1371

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/03/2008

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