MEDICARE: GREGORY MARTIN KEANE D.O.

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	2084P0800X	Psychiatry Physician	486	NE

General Provider Information

NPI Number	:	1386713527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY MARTIN KEANE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 641130
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-7130
Country	:	US
Telephone Number	:	402-717-4390
Fax Number	:	402-717-4280

Provider Business Practice Location Address
First Line	:	1309 HARLAN DR
Second Line	:	SUITE 206
City	:	BELLEVUE
State	:	NE
Zip	:	68005-6604
Country	:	US
Telephone Number	:	402-291-6789
Fax Number	:	402-291-8806

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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