Provider Demographics
NPI:1871049023
Name:KEYSTONE MEDICAL SERVICES OF WEST POINT INC
Entity type:Organization
Organization Name:KEYSTONE MEDICAL SERVICES OF WEST POINT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADA,S
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-795-3600
Mailing Address - Street 1:6075 POPLAR AVENUE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0114
Mailing Address - Country:US
Mailing Address - Phone:901-795-3600
Mailing Address - Fax:901-795-6060
Practice Address - Street 1:6075 POPLAR AVENUE
Practice Address - Street 2:SUITE 401
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0114
Practice Address - Country:US
Practice Address - Phone:901-795-3600
Practice Address - Fax:901-795-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty