Provider Demographics
NPI:1124057948
Name:CITY OF KEENE TEX
Entity type:Organization
Organization Name:CITY OF KEENE TEX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-339-4234
Mailing Address - Street 1:100 N MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-2323
Mailing Address - Country:US
Mailing Address - Phone:817-556-2474
Mailing Address - Fax:817-645-8080
Practice Address - Street 1:203 W HILLCREST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059
Practice Address - Country:US
Practice Address - Phone:817-648-7536
Practice Address - Fax:817-645-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3001103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088197101Medicaid
TX826590332Medicare PIN
TX505796Medicare PIN