KEITH PETTIBON MD – NPI #1467744573
Radiology

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Health Care Provider Taxonomy Code for Radiology

KEITH PETTIBON is a radiologist located in FORT WORTH, TX. NPPES has assigned the NPI number 1467744573 to KEITH PETTIBON on May 07, 2011. It is a Type-1 NPI, indicating this NPI number is associated with an individual. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 2085R0202X from the Health Care Provider Taxonomy code set, which is classified as Radiology, specializing in Diagnostic Radiology

The NPI profile was last updated on Jun 13, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for KEITH PETTIBON below.

NPI Profile for
KEITH PETTIBON

NPI Number
1467744573
Enumeration Date

(more than 15 years ago)
Entity Type
Type-1  Individual (Male)
Legal Name
KEITH PETTIBON
Credentials
MD
Primary location
815 PENNSYLVANIA AVE
FORT WORTH, TX 76104
Phone: (817) 321-0404 Fax:
Mailing address
816 W CANNON ST
FORT WORTH, TX 76104-3146
Phone: (817) 321-0404 Fax:
Sole Proprietor
Yes
Updated
Certification Date
Jun 13, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2085R0202X
- Radiology / Diagnostic Radiology (Primary)		 TX R1614
2085R0204X
- Radiology / Vascular & Interventional Radiology		 TX R1614

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Additional Information

Accepts Medicare
This provider may accept Medicare Assignment. The Medicare-approved amount is the total the doctor or supplier can be paid. When a doctor accepts the Medicare-approved amount as payment, you won't be billed for more than the Medicare deductible & coinsurance.
Medicare Ordering & Referring
Provider can:
  • Refer to Part B
  • Order Durable Medical Equipment
  • Refer to Home Health Agency
  • Order Power Mobility Devices
Affiliations
KEITH PETTIBON is affiliated with the following medical group(s):
  • HOSPITAL
    • BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER FORT WORTH
      1400 EIGHTH AVE
      FORT WORTH, TX 76104
    • MEDICAL CITY FORT WORTH
      900 EIGHTH AVENUE
      FORT WORTH, TX 76104
    • MEDICAL CITY WEATHERFORD
      713 E ANDERSON ST
      WEATHERFORD, TX 76086
    • METHODIST MANSFIELD MEDICAL CENTER
      2700 E BROAD STREET
      MANSFIELD, TX 76063
    • TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST F
      6100 HARRIS PKWY
      FORT WORTH, TX 76132

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