Basic Information
| Provider Information | |||||||||
| NPI: | 1790761047 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEITH | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 BOETTLER RD | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446857792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308960009 | ||||||||
| FaxNumber: | 3308960032 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 BOETTLER RD | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446857792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308960009 | ||||||||
| FaxNumber: | 3308960032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34007151 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080185622 | 01 | OH | RAILROAD MEDICARE | OTHER | 2275318 | 05 | OH | MEDICAID |