Healthcare Provider Details

I. General information

NPI: 1922183870
Provider Name (Legal Business Name): KEY MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15610 89TH STREET COURT KP N
LAKEBAY WA
98349-9551
US

IV. Provider business mailing address

PO BOX 129
VAUGHN WA
98394-0129
US

V. Phone/Fax

Practice location:
  • Phone: 253-884-9221
  • Fax: 253-884-5523
Mailing address:
  • Phone: 253-884-9221
  • Fax: 253-884-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. WILLIAM FREDRICK ROES
Title or Position: OWNER/PARTNER
Credential: MD
Phone: 253-884-9221