Organization
FALLBROOK-RANCHO SURGERY A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT NICOLAS KEENAN M.D. (PRESIDENT)
(951) 698-4650
Entity
Organization
Contact information
Practice address
1617 JOSHUA TREE LN, FALLBROOK, CA 92028-4334
(951) 698-4650
(951) 698-4651
Mailing address
1374 S MISSION RD STE 408, FALLBROOK, CA 92028-4006
(951) 698-4650
(951) 698-4651
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0081510
—
CA
01
—
YYY49687Y
SOUTHERN BLUE SHIELD
CA
01
—
ZZZ27707Z
NORTHERN BLUE SHIELD
CA
Enumeration date
07/13/2006
Last updated
11/16/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us