=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710238241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA KEYS MEDICAL TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2012
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91421 OVERSEAS HWY STE 102
-----------------------------------------------------
City | TAVERNIER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33070-2542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-414-8136
-----------------------------------------------------
Fax | 305-396-5889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1259
-----------------------------------------------------
City | TAVERNIER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33070-1259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-414-8136
-----------------------------------------------------
Fax | 305-396-5889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | EDWARD FRANCISCO BONILLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-414-8136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | ALS4411
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------