Provider Demographics
NPI:1679804363
Name:KEY BISCAYNE SURGICAL CENTER LLC
Entity type:Organization
Organization Name:KEY BISCAYNE SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-642-4263
Mailing Address - Street 1:180 CRANDON BLVD
Mailing Address - Street 2:114
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1555
Mailing Address - Country:US
Mailing Address - Phone:305-642-4263
Mailing Address - Fax:305-426-3329
Practice Address - Street 1:180 CRANDON BLVD
Practice Address - Street 2:114
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1555
Practice Address - Country:US
Practice Address - Phone:305-642-4263
Practice Address - Fax:305-426-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical