Healthcare Provider Details

I. General information

NPI: 1477876696
Provider Name (Legal Business Name): KEY BISCAYNE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 CRANDON BLVD SUITE #301
KEY BISCAYNE FL
33149-1832
US

IV. Provider business mailing address

580 CRANDON BLVD 301
KEY BISCAYNE FL
33149-1832
US

V. Phone/Fax

Practice location:
  • Phone: 305-365-7770
  • Fax: 305-365-7778
Mailing address:
  • Phone: 305-365-7770
  • Fax: 305-365-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROGER K KHOURI
Title or Position: PRESIDENT
Credential: MD
Phone: 305-642-4263