Keith A Micetich is a Specialist in Jackson, Tennessee. Keith A Micetich practices all healthcare services and medical treatments related to Specialist. The NPI Number for Keith A Micetich is 1427026137. The last update date is 2011-11-02.
Keith A Micetich's current location address is 72 Physicians Dr, Jackson, Tennessee. You can contact this provider via phone number 7316684455 and fax number 7316644508. The mailing address for Keith A Micetich is 72 Physicians Dr, Jackson, Tennessee. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Keith A Micetich |
|---|---|
| Address | 72 Physicians Dr, Jackson, Tennessee |
| Phone Number | 7316684455 |
| Fax Number | 7316644508 |
| Sole Proprietor | N |
| Credentials | MD |
NPI Number Detail
| NPI Number | 1427026137 |
|---|---|
| Provider Enumeration Date | 2006-03-09 |
| Last Updated Date | 2011-11-02 |
Provider Mailing Address Detail
| Address | 72 Physicians Dr |
|---|---|
| City | Jackson |
| State | Tennessee (TN) |
| Post Code | 383052070 |
| Phone Number | 7316684455 |
| Fax Number | 7316644508 |
Provider's Primary Taxonomy Detail
| Speciality | Specialist |
|---|---|
| Taxonomy | 174400000X |
| Licence No | 26274 |
|
Definition: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 3009628 | TN | BLUE CROSS BLUE SHIELD |
Post Comment/ Review Below
What is the unique 10-digit identification code issued to Keith A Micetich by the Centers for Medicare & Medicaid Services?
The Keith A Micetich has been assigned the NPI (National Provider Identifier) 1427026137 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Could you share the physical location details of Keith A Micetich?
The Keith A Micetich is situated at 72 Physicians Dr, in the city of Jackson, state of TN, with the zip code 383052070.
What is Keith A Micetich's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Keith A Micetich is Specialist, and the taxonomy classification code that categorizes this area of expertise is 174400000X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1427026137 to Keith A Micetich?
The Centers for Medicare & Medicaid Services originally issued the 1427026137 to Keith A Micetich on 2006-03-09.
As of what date was the information regarding Keith A Micetich, such as address, specialty, and other details, last verified and confirmed to be up-to-date?
The information related to Keith A Micetich, including its address, specialty, and other relevant details, was last verified and confirmed to be up-to-date on 2011-11-02.