Basic Information
| Provider Information | |||||||||
| NPI: | 1639143605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEELING | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1241 W MINERAL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801205685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037590854 | ||||||||
| FaxNumber: | 3037590864 | ||||||||
| Practice Location | |||||||||
| Address1: | HIGHWAY 9 AT PEAK ONE ROAD | ||||||||
| Address2: | ST ANTHONY SUMMIT MEDICAL CENTER, EMERGENCY DEPT | ||||||||
| City: | FRISCO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706683300 | ||||||||
| FaxNumber: | 9706688123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 04/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 29387 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200384240A | 05 | KS | MEDICAID | 122688600 | 05 | WY | MEDICAID | Z3270 | 05 | UT | MEDICAID | 01293877 | 05 | CO | MEDICAID | 129198 | 05 | AZ | MEDICAID | 73588571 | 05 | NM | MEDICAID |