Healthcare Provider Details

I. General information

NPI: 1679804363
Provider Name (Legal Business Name): KEY BISCAYNE SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 CRANDON BLVD 114
KEY BISCAYNE FL
33149-1555
US

IV. Provider business mailing address

180 CRANDON BLVD 114
KEY BISCAYNE FL
33149-1555
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-4263
  • Fax: 305-426-3329
Mailing address:
  • Phone: 305-642-4263
  • Fax: 305-426-3329

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: MANAGER
Credential: MD
Phone: 305-642-4263