Basic Information
| Provider Information | |||||||||
| NPI: | 1285630020 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUEST | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2858 SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036999073 | ||||||||
| FaxNumber: | 8665270937 | ||||||||
| Practice Location | |||||||||
| Address1: | 2858 SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036999073 | ||||||||
| FaxNumber: | 8665270937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | 20934 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207RG0300X | 20934 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP2916 | 05 | SC | MEDICAID | 380001558 | 01 | SC | RAILROAD MEDICARE | OTHER |