| Keystone Healthcare Systems Llc | |
|
105 Webster St Ste 5 Hanover MA 02339-1227 | |
| (901) 264-3704 | |
| Not Available |
| Full Name | Keystone Healthcare Systems Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 105 Webster St Ste 5, Hanover, Massachusetts |
| Authorized Official Name and Position | Caleb Solomon Brooks (OWNER) |
| Authorized Official Contact | 9012643704 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keystone Healthcare Systems Llc 105 Webster St Ste 5 Hanover MA 02339-1227 Ph: (901) 264-3704 | Keystone Healthcare Systems Llc 105 Webster St Ste 5 Hanover MA 02339-1227 Ph: (901) 264-3704 |
| NPI Number | 1992417018 |
|---|---|
| Provider Enumeration Date | 12/20/2022 |
| Last Update Date | 12/20/2022 |
| Certification Date | 12/20/2022 |
| Medicare PECOS PAC ID | 8022550078 |
|---|---|
| Medicare Enrollment ID | O20240606000944 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992417018 | NPI | - | NPPES |
| 1013448620 | Medicaid | MA | |
| 1851927511 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Caleb S. Brooks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851927511 PECOS PAC ID: 2264974211 Enrollment ID: I20240606001208 |
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