Keystone Mobile Partners, LP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

15331501 Issued in PA

Legal business name

KEYSTONE MOBILE PARTNERS, LP

Practice address

2701 Blair Mill Rd
Ste. 30
Willow Grove, PA 19090-1041

Phone

(215) 675-9900

Fax

(215) 675-4096

NPI assigned

Dec 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael A Dernoga

Title

Exec. Director

Phone

(215) 675-9900

Specialties & licenses 1

Addresses

Other names 1

• Keystone Kidney Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1083898787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 BLAIR MILL RD",
            "address_2": "STE. 30",
            "city": "WILLOW GROVE",
            "state": "PA",
            "postal_code": "190901041",
            "telephone_number": "215-675-9900",
            "fax_number": "215-675-4096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 BLAIR MILL RD",
            "address_2": "STE. 30",
            "city": "WILLOW GROVE",
            "state": "PA",
            "postal_code": "190901041",
            "telephone_number": "215-675-9900",
            "fax_number": "215-675-4096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE MOBILE PARTNERS, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "DERNOGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXEC. DIRECTOR",
        "authorized_official_telephone_number": "215-675-9900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": "15331501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keystone Kidney Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicky Kelepouris, MD
• Kevin J Kelly, M.D.
• Leslie A Kemper, MMFT
• Kent Lane Mueller DDS, LLC
• Shawn Kettyle
• Majid Afzal Khan, M.D.
• Saad Ahmed Khan, MD
• Greg Kidorf, PH.D.
• Erin Lynn Kilkenny, DPT, PT
• Jenny Kim, MS, OTR/L

• Ambulatory Surgical Clinic/Center in Willow Grove, PA
• Providers in Willow Grove, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.