Provider Demographics
NPI:1285800300
Name:BIRKHEAD, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:BIRKHEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-0117
Mailing Address - Country:US
Mailing Address - Phone:620-241-4385
Mailing Address - Fax:620-241-3157
Practice Address - Street 1:1325 N MAXWELL ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2705
Practice Address - Country:US
Practice Address - Phone:620-241-4385
Practice Address - Fax:620-241-3157
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant