Basic Information
| Provider Information | |||||||||
| NPI: | 1902840945 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEIM | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 COX RD | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230609263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049685700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 545 W MAIN ST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | TRAPPE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104899374 | ||||||||
| FaxNumber: | 6104896418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 06/08/2018 | ||||||||
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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 | MD048414L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0331154000 | 01 | PA | AMERIHEALTH/INTERCOUNTY | OTHER | 163035 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 2125273 | 01 | PA | ALLIANCE/OPT CHC (MAMSI) | OTHER | 4291748 | 01 | PA | AETNA PPO | OTHER | 0015091240007 | 05 | PA | MEDICAID | 0696535 | 01 | PA | CIGNA HMO/PPO | OTHER | 080184959 | 01 | PA | RRM | OTHER | 11045632 | 01 | PA | MULTIPLAN | OTHER | 3224116 | 01 | PA | AETNA HMO | OTHER | 11025245 | 01 | PA | CAQH ID# | OTHER | 1164062 | 01 | PA | KEYSTONE MERCY | OTHER | 0331154000 | 01 | PA | IBC - PC/KHPE | OTHER |