Basic Information
| Provider Information | |||||||||
| NPI: | 1205872330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEENER | ||||||||
| FirstName: | ALTHEA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NELSON | ||||||||
| OtherFirstName: | ALTHEA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 304 N WATER ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176033374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172996371 | ||||||||
| FaxNumber: | 7179451587 | ||||||||
| Practice Location | |||||||||
| Address1: | 304 N WATER ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176033374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172996372 | ||||||||
| FaxNumber: | 7179451584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 03/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD051160L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31195 | 01 | PA | HEALTH PARTNERS | OTHER | 54819 | 01 | PA | HEALTHAMERICA | OTHER | 7091635 | 01 | PA | AETNA-NON HMO | OTHER | P002759 | 01 | PA | GATEWAY HEALTHPLAN | OTHER | 1100849 | 01 | PA | KEYSTONE MERCY | OTHER | 50055971 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 000000127166 | 01 | PA | UNISON HEALTHPLAN | OTHER | 000000149538 | 01 | PA | UNISON HEALTHPLAN | OTHER | 000816293 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 001561231 0001 | 05 | PA | MEDICAID | 1100849 | 01 | PA | AMERIHEALTH MERCY | OTHER | 50055971 | 01 | PA | KEYSTONE HEALTH PLAN CENTRAL | OTHER | 50069824 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 0845709000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER |