1548632466 NPI number — KEY ANESTHESIA LLC

Table of content: (NPI 1548632466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548632466 NPI number — KEY ANESTHESIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEY ANESTHESIA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548632466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
580 CRANDON BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
KEY BISCAYNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33149-1832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-365-7770
Provider Business Mailing Address Fax Number:
305-365-7778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 CRANDON BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
KEY BISCAYNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33149-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-365-7770
Provider Business Practice Location Address Fax Number:
305-365-7778
Provider Enumeration Date:
10/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KHOURI
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-365-7770

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 016980100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com