MEDICARE: KEITH A POOLE DO

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	207Q00000X	Family Medicine Physician	1840	WV
2	207Q00000X	Family Medicine Physician	34.007929	OH

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487609558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH A POOLE DO

Provider Business Mailing Address
First Line	:	51339 NATIONAL RD
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-9119
Country	:	US
Telephone Number	:	740-635-4572
Fax Number	:	740-635-4575

Provider Business Practice Location Address
First Line	:	55741 NATIONAL ROAD
Second Line	:
City	:	BRIDGEPORT
State	:	OH
Zip	:	43912
Country	:	US
Telephone Number	:	740-635-4572
Fax Number	:	740-635-4575

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/15/2022

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Directions to “ KEITH A POOLE DO” Practice Location

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