MEDICARE: JIM E KELLER PA-C

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	363A00000X	Physician Assistant	2055	CO

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	:	1477628253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM E KELLER PA-C

Provider Business Mailing Address
First Line	:	10251 PENNINGTON LN
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-5584
Country	:	US
Telephone Number	:	303-346-5412
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 15TH AVE
Second Line	:
City	:	IDAHO SPRINGS
State	:	CO
Zip	:	80452
Country	:	US
Telephone Number	:	303-567-2668
Fax Number	:

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	02/05/2008

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Directions to “ JIM E KELLER PA-C” Practice Location

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