Provider Demographics
NPI:1194960807
Name:KEITH M RAMSEY MEDICAL CORP
Entity type:Organization
Organization Name:KEITH M RAMSEY MEDICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-545-3423
Mailing Address - Street 1:1512 BURR ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46406-2369
Mailing Address - Country:US
Mailing Address - Phone:219-944-3933
Mailing Address - Fax:219-944-2473
Practice Address - Street 1:7863 BROADWAY STE 244
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5553
Practice Address - Country:US
Practice Address - Phone:773-991-3602
Practice Address - Fax:219-962-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036485A207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100201350AMedicaid
IL036068254OtherILLINOIS MEDICAID
IL0090000637OtherBLUE CROSS/BLUE OF ILLINOIS
IN000000090423OtherBLUE CROSS/BLUE SHIELD
IL036068254OtherILLINOIS MEDICAID
IN100201350AMedicaid