Provider Demographics
NPI:1225384340
Name:RURAL HEALTH NETWORK OF MONROE COUNTY, FLORIDA, INC.
Entity Type:Organization
Organization Name:RURAL HEALTH NETWORK OF MONROE COUNTY, FLORIDA, INC.
Other - Org Name:LOWER KEYS COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBA
Authorized Official - Phone:305-517-6613
Mailing Address - Street 1:3706 N ROOSEVELT BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4566
Mailing Address - Country:US
Mailing Address - Phone:305-517-6613
Mailing Address - Fax:305-517-6617
Practice Address - Street 1:3706 N ROOSEVELT BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4566
Practice Address - Country:US
Practice Address - Phone:305-517-6613
Practice Address - Fax:305-517-6617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTH NETWORK OF MONROE COUNTY, FLORIDA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-26
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49975251S00000X
FL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006558500Medicaid
FL006558501Medicaid