Provider Demographics
NPI:1710238241
Name:FLORIDA KEYS AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:FLORIDA KEYS AMBULANCE SERVICE, INC.
Other - Org Name:FLORIDA KEYS AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER, CEO.
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P, CCT-P
Authorized Official - Phone:305-414-8136
Mailing Address - Street 1:PO BOX 1259
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-1259
Mailing Address - Country:US
Mailing Address - Phone:305-414-8136
Mailing Address - Fax:305-396-5889
Practice Address - Street 1:91421 OVERSEAS HWY STE 10
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2542
Practice Address - Country:US
Practice Address - Phone:305-414-8136
Practice Address - Fax:305-396-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLALS44113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLALS4411OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH