Provider Demographics
NPI:1871773754
Name:AMY KEYWOOD
Entity type:Organization
Organization Name:AMY KEYWOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-894-1616
Mailing Address - Street 1:405 GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2805
Mailing Address - Country:US
Mailing Address - Phone:601-894-1616
Mailing Address - Fax:601-894-1605
Practice Address - Street 1:405 GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2805
Practice Address - Country:US
Practice Address - Phone:601-894-1616
Practice Address - Fax:601-894-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5748380001Medicare NSC