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General NPI Number Information
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NPI Number | 1982004933
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Entity Type | Organization
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Legal Business Name | OLD TOWN MEDICAL CENTERS, LLC
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 540 TRUMAN AVE
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City | KEY WEST
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State | FL
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Zip | 33040-3141
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Country | US
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Telephone | 305-394-1792
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Fax |
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Provider Business Mailing Address
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Address Line | 540 TRUMAN AVE
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City | KEY WEST
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State | FL
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Zip | 33040-3141
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Country | US
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Telephone | 305-394-1792
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Fax |
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Authorized Official
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Title or Position | AP
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Name | TIMOTHY MACKEY
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Credential | DO
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Telephone | 305-394-1792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 51339
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9168222
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS9185
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License Number State | FL
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