Provider Demographics
NPI:1528704921
Name:KEITH A NORVILL DO LOCUM TENENS
Entity type:Organization
Organization Name:KEITH A NORVILL DO LOCUM TENENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NORVILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-248-4260
Mailing Address - Street 1:122 GARDEN EDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6084
Mailing Address - Country:US
Mailing Address - Phone:719-248-4260
Mailing Address - Fax:
Practice Address - Street 1:180 MEDICAL PARK PL STE 201
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8067
Practice Address - Country:US
Practice Address - Phone:719-248-4260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty