1710238241 NPI number — FLORIDA KEYS MEDICAL TRANSPORTATION LLC

Table of content: (NPI 1710238241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710238241 NPI number — FLORIDA KEYS MEDICAL TRANSPORTATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA KEYS MEDICAL TRANSPORTATION LLC
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:
6
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:
1710238241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1259
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAVERNIER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33070-1259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-414-8136
Provider Business Mailing Address Fax Number:
305-396-5889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91421 OVERSEAS HWY STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAVERNIER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33070-2542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-414-8136
Provider Business Practice Location Address Fax Number:
305-396-5889
Provider Enumeration Date:
09/24/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BONILLA
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
FRANCISCO
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
305-414-8136

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  ALS4411 , 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)

  • Identifier: ALS4411 . This is a "FLDOH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 007253400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".