MEDICARE: MR. KEITH PHILIP HAYES LMT/CNMT

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	174400000X	Specialist	5111	NM

General Provider Information

NPI Number	:	1508040155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH PHILIP HAYES LMT/CNMT

Provider Business Mailing Address
First Line	:	2509 VERMONT ST. NE
Second Line	:	ST. C #104
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110
Country	:	US
Telephone Number	:	505-417-9491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 VERMONT ST NE
Second Line	:	ST. C #104
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4688
Country	:	US
Telephone Number	:	505-417-9491
Fax Number	:

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

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	05/30/2013

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