MEDICARE: JEFFREY JOHN KEECH

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	372600000X	Adult Companion

General Provider Information

NPI Number	:	1407275092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY JOHN KEECH

Provider Business Mailing Address
First Line	:	1333 ST JOSEPH ST
Second Line	:	UNIT 12
City	:	DALLAS
State	:	TX
Zip	:	75204
Country	:	US
Telephone Number	:	817-832-9908
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 SAINT JOSEPH ST
Second Line	:	UNIT 12
City	:	DALLAS
State	:	TX
Zip	:	75204-6507
Country	:	US
Telephone Number	:	817-832-9908
Fax Number	:

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

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	04/10/2014

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