Basic Information
| Provider Information | |||||||||
| NPI: | 1124024625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | OSMOND | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | COMMUNITY HOSPITALISTS, LLC | ||||||||
| Address2: | PO BOX 39413 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405235023 | ||||||||
| FaxNumber: | 4405235029 | ||||||||
| Practice Location | |||||||||
| Address1: | SOUTHWEST GENERAL HEALTH CENTER | ||||||||
| Address2: | 18697 BAGLEY ROAD | ||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408168000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-08-2150-0 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | ME101224 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2386850 | 05 | OH | MEDICAID |