| Philip A Keith, MD | |
|
225 Memorial Dr, Berlin, WI 54923-1243 | |
| (920) 361-5524 | |
| (920) 361-5486 |
| Full Name | Philip A Keith |
|---|---|
| Gender | Male |
| Speciality | Diagnostic Radiology |
| Experience | 22 Years |
| Location | 225 Memorial Dr, Berlin, Wisconsin |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831275890 | NPI | - | NPPES |
| 1831275890 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 47873-020 (Wisconsin) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Thedacare Regional Medical Center - Appleton Inc | Appleton, WI | Hospital |
| Berlin Memorial Hospital | Berlin, WI | Hospital |
| Thedacare Medical Center - Shawano | Shawano, WI | Hospital |
| Thedacare Medical Center - Wild Rose | Wild rose, WI | Hospital |
| Thedacare Regional Med Ctr - Neenah | Neenah, WI | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Thedacare Incorporated | 1759294887 | 533 |
| Radiology Associates Of Appleton Sc | 6002851862 | 29 |
| Entity Name | Thedacare Incorporated |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1376656959 PECOS PAC ID: 1759294887 Enrollment ID: O20031106000088 |
| Entity Name | Radiology Associates Of Appleton Sc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1407941909 PECOS PAC ID: 6002851862 Enrollment ID: O20050622000606 |
| Entity Name | Premier Radiology Wisconsin Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1952951154 PECOS PAC ID: 9537595533 Enrollment ID: O20200211002818 |
| Mailing Address | Practice Location Address |
|---|---|
| Philip A Keith, MD 225 Memorial Dr, Berlin, WI 54923-1243 Ph: (920) 361-5524 | Philip A Keith, MD 225 Memorial Dr, Berlin, WI 54923-1243 Ph: (920) 361-5524 |
Brice Alvord, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 225 Memorial Dr, Berlin, WI 54923 Phone: 920-361-5730 Fax: 920-361-5519 |