Provider Demographics
NPI:1760430987
Name:FLORIDA KEYS ORTHOPEDIC AND SPORTS MEDICINE CENTER INC
Entity Type:Organization
Organization Name:FLORIDA KEYS ORTHOPEDIC AND SPORTS MEDICINE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-453-3633
Mailing Address - Street 1:100210 OVERSEAS HWY
Mailing Address - Street 2:STE 3
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2527
Mailing Address - Country:US
Mailing Address - Phone:305-453-3633
Mailing Address - Fax:305-453-3637
Practice Address - Street 1:100210 OVERSEAS HWY
Practice Address - Street 2:STE 3
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2527
Practice Address - Country:US
Practice Address - Phone:305-453-3633
Practice Address - Fax:305-453-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379646900Medicaid
FLF67907Medicare UPIN
FL23444Medicare PIN
FL1134040001Medicare NSC