DR. MARK R KEANE (NPI# 1427044643) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427044643 |
| Entity Type | Individual |
| Full Name | DR. MARK R KEANE |
| Credential | M.D. |
| Practice Address |
307 Saint Johns Way Ste 1 Lewiston ID 83501-2435 |
| Practice Telephone | 2087507474 |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2019-12-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
24256 | AZ | Allopathic & Osteopathic Physicians |
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD00037909 | WA | Allopathic & Osteopathic Physicians |
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
M7728 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7088867 | 05 | |
| WA | L & I WA | 128039 | 01 |
| ID | 805433500 | 05 | |
| WA | 8239543 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 338 6th St, Suite 102, Lewiston, ID 835012419 | 2087463320 | 2087468717 |
| Street Address |
307 SAINT JOHNS WAY STE 1 |
| City | LEWISTON |
| State | ID |
| Zip Code | 83501-2435 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881695534 | Jean K Thomas | Psychiatry & Neurology | 307 Saint Johns Way Ste 1, Lewiston, ID 83501-2435 | 2005-08-03 |
| 1619061447 | Lisa L Kaltenbaugh | Registered Nurse | 307 Saint Johns Way Ste 1, Lewiston, ID 83501-2435 | 2006-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679193759 | Jacqueline M Aldrich | Behavior Technician | 3407 12th Street C, 3407 12th Street C, Lewiston, ID 83501 | 2020-04-20 |
| 1295228054 | Provident Foundation - Wedgewood Terrace LLC | Alzheimer Center (Dementia Center) | 2114 Vineyard Avenue, Lewiston, ID 83501 | 2018-06-07 |
| 1164945325 | Xiaofei Liu | Massage Therapist | 234 Thain Rd, Lewiston, ID 83501 | 2017-07-19 |
| 1467909879 | Sharon Thulon | Registered Nurse | 1118 F Street, Lewiston, ID 83501 | 2016-09-01 |
| 1821459496 | Gem State Endoscopy | Clinic/Center | 3709 14th Street, Lewiston, ID 83501 | 2016-03-10 |
| 1508264995 | Gary L. Grogan | Psychologist | 633 Main Street, B#1, Lewiston, ID 83501 | 2014-12-17 |
| 1003189366 | John Joseph Johnson | Dentist | 3510 12th Street, Suite #600, Lewiston, ID 83501 | 2012-02-17 |
| 1306134077 | Rowena Kathryn Jackson | Counselor | 531 Bryden Avenue, Lewiston, ID 83501 | 2011-07-15 |
| 1912290388 | Staci Leanne Truby | Massage Therapist | 717 'd' Street, Lewiston, ID 83501 | 2011-05-18 |
| 1093040685 | Sharie Ann Uhlorn | Registered Nurse | 1837 Alder Court, Lewiston, ID 83501 | 2009-10-15 |
| Find all providers in zip 83501 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316090426 | Affiliated Neurologists Pllc | Psychiatry & Neurology | 338 6th St, Suite 102, Lewiston, ID 83501-2419 | 2007-01-19 |
| 1174691273 | Elizabeth Anne Doherty | Psychiatry & Neurology | 819 Hackney Ln, Lewiston, NY 14092-2053 | 2006-11-30 |
| 1407958994 | Bradley Thomas Truax | Psychiatry & Neurology | 471 Fort Gray Dr, Lewiston, NY 14092-1941 | 2006-09-04 |
| 1639103997 | Carl D Robinson | Psychiatry & Neurology | 99 Campus Ave Ste 402, Lewiston, ME 04240-6045 | 2006-07-10 |
| 1881695534 | Jean K Thomas | Psychiatry & Neurology | 307 Saint Johns Way Ste 1, Lewiston, ID 83501-2435 | 2005-08-03 |
| 1730476839 | Alison Claire Daigle | Psychiatry & Neurology | 99 Campus Ave, Suite 402, Lewiston, ME 04240-6045 | 2011-07-09 |
| 1033412069 | Baljinder Singh | Psychiatry & Neurology | 5320 Military Rd, Suite 101, Lewiston, NY 14092-2149 | 2010-12-14 |
| 1003137050 | William R. Bozarth, M.d., P.s. | Psychiatry & Neurology | 338 6th St, Suite 102, Lewiston, ID 83501-2419 | 2010-06-14 |
| 1356539415 | Baljinder Singh | Psychiatry & Neurology | 5300 Military Rd, Lewiston, NY 14092-1903 | 2007-10-13 |
| 1922217678 | Natasha Vanessa Demattos | Psychiatry & Neurology | 3326 4th St, Suite 6, Lewiston, ID 83501-5890 | 2007-05-21 |
| Find all providers in LEWISTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.