1871885202 NPI number — KRIS M BLY MEDICAL SERVICES P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871885202 NPI number — KRIS M BLY MEDICAL SERVICES P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KRIS M BLY MEDICAL SERVICES P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871885202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 EVERGREEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEY WEST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33040-6244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-735-3920
Provider Business Mailing Address Fax Number:
305-328-8304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3420 DUCK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEY WEST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33040-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-296-5358
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BLY
Authorized Official First Name:
KRIS
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
305-509-1447

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  OS10451 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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