Provider Demographics
NPI:1982709317
Name:KEY WEST COMMUNITY DIAGNOSTIC COMPANY, LLC
Entity type:Organization
Organization Name:KEY WEST COMMUNITY DIAGNOSTIC COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-296-3146
Mailing Address - Street 1:3414 DUCK AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4427
Mailing Address - Country:US
Mailing Address - Phone:305-295-9771
Mailing Address - Fax:305-295-0059
Practice Address - Street 1:3414 DUCK AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4427
Practice Address - Country:US
Practice Address - Phone:305-295-9771
Practice Address - Fax:305-295-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8585Medicare ID - Type UnspecifiedPROVIDER NUMBER