Provider Demographics
NPI:1639128267
Name:MIDDLE KEYS ANESTHESIA ASSOCIATES PA
Entity type:Organization
Organization Name:MIDDLE KEYS ANESTHESIA ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-743-0222
Mailing Address - Street 1:103 PIRATES CV
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2925
Mailing Address - Country:US
Mailing Address - Phone:305-743-0222
Mailing Address - Fax:305-743-0114
Practice Address - Street 1:3301 OVERSEAS HWY
Practice Address - Street 2:FISHERMEN'S HOSPITAL ANESTHESIA DEPT
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2329
Practice Address - Country:US
Practice Address - Phone:305-289-6407
Practice Address - Fax:305-289-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ5238OtherRAILROAD MEDICARE
170677600OtherUS DEPT OF LABOR
FL38390OtherBLUE CROSS BLUE SHIELD FL
FL263445700Medicaid
FL263445700Medicaid