Provider Demographics
NPI:1215039409
Name:KEY WEST SURGICAL GROUP INC
Entity Type:Organization
Organization Name:KEY WEST SURGICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING-CODING
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEGURA-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-294-1041
Mailing Address - Street 1:3136 NORHTSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-8027
Mailing Address - Country:US
Mailing Address - Phone:305-294-1041
Mailing Address - Fax:305-293-0990
Practice Address - Street 1:3136 NORHTSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-8027
Practice Address - Country:US
Practice Address - Phone:305-294-1041
Practice Address - Fax:305-293-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255847500Medicaid
FL255847500Medicaid
FL255847500Medicaid