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1111 12th St Ste 109 Key West FL 33040-4087 | |
| (305) 296-1558 | |
| (305) 296-1562 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine - Pulmonary Disease |
| Location | 1111 12th St Ste 109, Key West, Florida |
| Authorized Official Name and Position | Jennifer L Jackson (SR DIR PROV ENROLLMENT & ONBOARDING) |
| Authorized Official Contact | 6154653334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7211 | 1111 12th St Ste 109 Key West FL 33040-4087 Ph: (305) 296-1558 |
| NPI Number | 1740858364 |
|---|---|
| Provider Enumeration Date | 06/11/2021 |
| Last Update Date | 03/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740858364 | NPI | - | NPPES |
| 272815014 | Medicaid | FL |
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