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Organization
KEY WEST MEDICAL GROUP P A
Active
Organization
KEY WEST MEDICAL GROUP P A
Active
Other names
SOUTHERN MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA LACOVA (BILLING MANAGER)
(954) 426-1186
Entity
Organization
Contact information
Practice address
1111 12TH ST, SUITE210, KEY WEST, FL 33040-4088
(305) 296-2414
Mailing address
1111 12TH ST, SUITE210, KEY WEST, FL 33040-4088
(305) 296-2414
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067849000
—
FL
Enumeration date
01/18/2007
Last updated
02/11/2011
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