MEDICARE: SAMUEL JAMES KECK-FLORY MD

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	125080643	IL

General Provider Information

NPI Number	:	1679203756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL JAMES KECK-FLORY MD

Provider Business Mailing Address
First Line	:	103 SOUTHPOINTE DR STE A
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-3780
Country	:	US
Telephone Number	:	618-656-2000
Fax Number	:	618-656-1169

Provider Business Practice Location Address
First Line	:	103 SOUTHPOINTE DR STE A
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-3780
Country	:	US
Telephone Number	:	618-656-2000
Fax Number	:	618-656-1169

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

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/03/2026

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