MEDICARE: KEITH A. NORVILL D.O.

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	207T00000X	Neurological Surgery Physician	J 3562	TX
2	207T00000X	Neurological Surgery Physician	49685	CO
3	207T00000X	Neurological Surgery Physician	E-12658	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00997257	OTHER	CO	RAILROAD MEDICARE

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

General Provider Information

NPI Number	:	1770553075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH A. NORVILL D.O.

Provider Business Mailing Address
First Line	:	122 GARDEN EDGE DR
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6084
Country	:	US
Telephone Number	:	719-248-4260
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 MEDICAL PARK PL STE 201
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-8067
Country	:	US
Telephone Number	:	719-248-4260
Fax Number	:

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	05/09/2022

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Directions to “ KEITH A. NORVILL D.O.” Practice Location

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