Provider Demographics
NPI:1972619625
Name:A1-URGENT CARE & FAMILY PRACTICE CENTER KEY LARGO, PA
Entity Type:Organization
Organization Name:A1-URGENT CARE & FAMILY PRACTICE CENTER KEY LARGO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-453-3006
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-0998
Mailing Address - Country:US
Mailing Address - Phone:305-453-3006
Mailing Address - Fax:305-453-3310
Practice Address - Street 1:99198 OVERSEAS HWY STE 2
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2437
Practice Address - Country:US
Practice Address - Phone:305-453-3006
Practice Address - Fax:305-453-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0003371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370516100Medicaid
FL95144OtherBLUE CROSS BLUE SHIELD
FL930106664OtherRAILROAD MEDICARE ID
FL95144OtherBLUE CROSS BLUE SHIELD
FL930106664OtherRAILROAD MEDICARE ID