Healthcare Provider Details

I. General information

NPI: 1639178791
Provider Name (Legal Business Name): KEY LARGO VOLUNTEER AMBULANCE CORP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98600 OVERSEAS HWY
KEY LARGO FL
33037
US

IV. Provider business mailing address

PO BOX 5847
GAINESVILLE GA
30504-0847
US

V. Phone/Fax

Practice location:
  • Phone: 305-451-2766
  • Fax: 305-451-1562
Mailing address:
  • Phone: 877-288-8561
  • Fax: 770-297-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: HOLLY HIRNEISEN
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 770-297-0440