Healthcare Provider Details

I. General information

NPI: 1710206727
Provider Name (Legal Business Name): USCG KEY WEST CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TRUMBO RD
KEY WEST FL
33040-6655
US

IV. Provider business mailing address

100 TRUMBO RD
KEY WEST FL
33040-6655
US

V. Phone/Fax

Practice location:
  • Phone: 303-292-8828
  • Fax:
Mailing address:
  • Phone: 303-292-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBRA FITZGERALD
Title or Position: HEALTH SYSTEMS ANALYST
Credential:
Phone: 757-628-4363