Basic Information
Provider Information | |||||||||
NPI: | 1275626947 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOWELL | ||||||||
FirstName: | KEITH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2003 KOOTENAI HEALTH WAY | ||||||||
Address2: |   | ||||||||
City: | COEUR D ALENE | ||||||||
State: | ID | ||||||||
PostalCode: | 838146051 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2084765777 | ||||||||
FaxNumber: | 2084765385 | ||||||||
Practice Location | |||||||||
Address1: | 1412 MILSTEAD AVENUE | ||||||||
Address2: |   | ||||||||
City: | CONYERS | ||||||||
State: | GA | ||||||||
PostalCode: | 30012 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7709949326 | ||||||||
FaxNumber: | 7709944747 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/02/2006 | ||||||||
LastUpdateDate: | 02/16/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/16/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 64873 | MN | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207PE0004X | 45830 | GA | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207P00000X | M13529 | ID | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | 45830 | GA | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.