Jack C. Keen, M.D.
Individual provider Active NPI Specialist · Cresson, TX
NPI 1063759652 · NPPES record last updated Jan 15, 2013
Key facts
- NPI
- 1063759652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- G4144 (TX)
- Practice address
- 408 Stone Mountain CT
Cresson, TX 76035-5628 - Phone
- (817) 512-3006
- NPI assigned
- Jan 15, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G4144 | TX | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | G4144 | TX | Yes |
Addresses
Primary practice location
408 Stone Mountain CT
Cresson, TX 76035-5628
Mailing address
408 Stone Mountain CT
Cresson, TX 76035-5628
Phone (817) 512-3006
Other providers in Cresson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.