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NPI Code Detail

MEDICARE: JAMES EDGAR KEEGAN RBT

MEDICARE: JAMES EDGAR KEEGAN RBT
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
1106S00000XBehavior TechnicianRBT-24-354406CO

General Provider Information

NPI Number : 1861222150
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES EDGAR KEEGAN RBT
Provider Business Mailing Address
First Line : 11681 VOYAGER PKWY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-3861
Country : US
Telephone Number : 719-344-9342
Fax Number :
Provider Business Practice Location Address
First Line : 11681 VOYAGER PKWY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-3861
Country : US
Telephone Number : 719-344-9342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2024
Last Update Date : 08/02/2024

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