Provider Demographics
NPI:1356494777
Name:KEYES SURGICAL ASSIST INC
Entity Type:Organization
Organization Name:KEYES SURGICAL ASSIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT CERTIFIED
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:772-398-9763
Mailing Address - Street 1:132 WIDE RIVER CV
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9132
Mailing Address - Country:US
Mailing Address - Phone:772-398-9763
Mailing Address - Fax:772-337-7548
Practice Address - Street 1:1700 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4803
Practice Address - Country:US
Practice Address - Phone:772-461-4000
Practice Address - Fax:772-467-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2081363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLX1622OtherBCBS
FLDF1932OtherMEDICARE RAILROAD
65113OtherMETCARE
FLY49781Medicare UPIN
FLDF1932OtherMEDICARE RAILROAD