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DR. KEITH A MICETICH MD
NPI 1427026137
Specialist in Jackson, TN

Active since March 09, 2006PECOS Enrolled
72 PHYSICIANS DR, JACKSON, TN 38305(731) 668-4455(731) 668-9007 Get Directions Write a Review

NPPES record last updated: November 2, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Keith A Micetich Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KEITH A MICETICH MD (NPI 1427026137) is an individual specialist in Jackson, Tennessee, licensed in Tennessee (26274) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1427026137
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameDR. KEITH A MICETICHCredential: MD
Location Address72 PHYSICIANS DRJackson, TN 38305-2070
Mailing Address72 Physicians DrJackson, TN 38305-2070 · (731) 668-4455 · Fax (731) 664-4508
Phone(731) 668-4455
Fax(731) 668-9007
Sole ProprietorNo
Enumeration DateMarch 9, 2006
Last NPPES UpdateNovember 2, 2011
✔ NPI 1427026137 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in TN · 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.
72 PHYSICIANS DR, Jackson, TN 38305
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Other Identifiers 3

Medicare ID-Type Unspecified3091718TN
Other3009628TN · Blue Cross Blue Shield
Medicare UPING16712TN

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Keith A Micetich Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RACHEL HOLMES FNP-C
Nurse Practitioner (Family)
72 PHYSICIANS DR
JACKSON, TN 38305
Madison County (731) 668-4455
JACKSON REGIONAL WOMENS CENTER
Obstetrics & Gynecology
72 PHYSICIANS DR
JACKSON, TN 38305
Madison County (731) 668-4455
DR. TAYLER M JOHNSTON DNP, CNM, WHNP
Advanced Practice Midwife
72 PHYSICIANS DR
JACKSON, TN 38305
Madison County (731) 668-4455
AMANDA LYNN NOLD PA-C
Physician Assistant
72 PHYSICIANS DR
JACKSON, TN 38305
Madison County (731) 660-6395

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keith Micetich's NPI number?

The NPI number for Keith Micetich is 1427026137. It was assigned to this individual provider in the NPPES registry on March 9, 2006.

Where is Keith Micetich located?

Keith Micetich practices at 72 Physicians Dr, Jackson, TN 38305. The listed phone number is (731) 668-4455.

What is Keith Micetich's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Keith Micetich enrolled in Medicare?

Yes. Keith Micetich is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Keith Micetich was last updated on November 2, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.