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3706 N Roosevelt Blvd Ste C Key West FL 33040-4566 | |
| (305) 517-6613 | |
| (305) 517-6617 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3706 N Roosevelt Blvd Ste C, Key West, Florida |
| Authorized Official Name and Position | Amy Halstead (CEO) |
| Authorized Official Contact | 3055176613 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3706 N Roosevelt Blvd Ste C Key West FL 33040-4566 Ph: (305) 517-6613 | 3706 N Roosevelt Blvd Ste C Key West FL 33040-4566 Ph: (305) 517-6613 |
| NPI Number | 1225384340 |
|---|---|
| Provider Enumeration Date | 07/26/2012 |
| Last Update Date | 12/11/2024 |
| Medicare PECOS PAC ID | 1658281498 |
|---|---|
| Medicare Enrollment ID | O20131014000719 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225384340 | NPI | - | NPPES |
| 006558501 | Medicaid | FL | |
| 006558500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Florida) | Primary |
| Provider Name | Taweh Beysolow |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1720065212 PECOS PAC ID: 9830241975 Enrollment ID: I20090721000139 |
| Provider Name | Sharon V Ward |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386759504 PECOS PAC ID: 6204094907 Enrollment ID: I20120227000809 |
| Provider Name | Mary E Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174636997 PECOS PAC ID: 6103059670 Enrollment ID: I20140507002057 |
| Provider Name | Deborah L Ransbottom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376730465 PECOS PAC ID: 1951466176 Enrollment ID: I20171009000301 |
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