Provider Demographics
NPI:1104906403
Name:KEENE MEDICAL PRODUCTS, LLC
Entity type:Organization
Organization Name:KEENE MEDICAL PRODUCTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEMS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-448-5290
Mailing Address - Street 1:5 LANDING RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03748-3545
Mailing Address - Country:US
Mailing Address - Phone:603-448-5290
Mailing Address - Fax:
Practice Address - Street 1:603 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-4903
Practice Address - Country:US
Practice Address - Phone:603-752-7694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0462490006Medicare NSC