Provider Demographics
NPI:1164008371
Name:CEDAR KEY HEALTHCARE LLC
Entity Type:Organization
Organization Name:CEDAR KEY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:N
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-325-0474
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:CEDAR KEY
Mailing Address - State:FL
Mailing Address - Zip Code:32625-0297
Mailing Address - Country:US
Mailing Address - Phone:352-325-0474
Mailing Address - Fax:
Practice Address - Street 1:510 2ND ST
Practice Address - Street 2:
Practice Address - City:CEDAR KEY
Practice Address - State:FL
Practice Address - Zip Code:32625
Practice Address - Country:US
Practice Address - Phone:352-325-0474
Practice Address - Fax:352-477-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty