Basic Information
| Provider Information | |||||||||
| NPI: | 1649646324 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEYSTONE EMERGENCY MEDICAL SERVICES OF TX | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 W SWANN AVE | ||||||||
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| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336062639 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6075 POPLAR AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381190114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017953600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2015 | ||||||||
| LastUpdateDate: | 08/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | OKEKE | ||||||||
| AuthorizedOfficialFirstName: | THEOPHILUS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8006692640 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.