| Stewart Keller Do Pa | |
|
1314 Lake St Suite 102 Fort Worth TX 76102-4581 | |
| (817) 348-8333 | |
| (817) 348-8415 |
| Full Name | Stewart Keller Do Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1314 Lake St, Fort Worth, Texas |
| Authorized Official Name and Position | Stewart R Keller (OWNER) |
| Authorized Official Contact | 8173488333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stewart Keller Do Pa 1314 Lake St Suite 102 Fort Worth TX 76102-4581 Ph: (817) 348-8333 | Stewart Keller Do Pa 1314 Lake St Suite 102 Fort Worth TX 76102-4581 Ph: (817) 348-8333 |
| NPI Number | 1225080856 |
|---|---|
| Provider Enumeration Date | 05/16/2006 |
| Last Update Date | 06/23/2008 |
| Medicare PECOS PAC ID | 7113931866 |
|---|---|
| Medicare Enrollment ID | O20060201000687 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225080856 | NPI | - | NPPES |
| 0003QJ | Other | TX | BCBS |
| DE2226 | Other | MEDICARE RAILROAD | |
| 179056001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Stewart R Keller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881647295 PECOS PAC ID: 2163490392 Enrollment ID: I20040924000095 |
| Provider Name | Atemnkeng F Dibaki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750758512 PECOS PAC ID: 3476836123 Enrollment ID: I20170203001555 |
| Provider Name | Nnene N Egbe-tambe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417541194 PECOS PAC ID: 6901298728 Enrollment ID: I20220127001858 |
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