# OLD TOWN COMMUNITY HEALTH CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548488778
- **Authorized official:** IVIS FONSECA (BILLING MANAGER)
- **Authorized official phone:** (305) 292-3600

## Contact information

- **Practice address:** 3134 NORTHSIDE DR, KEY WEST, FL 33040-8004
- **Practice address phone:** (305) 296-8593
- **Mailing address:** 3134 NORTHSIDE DR, KEY WEST, FL 33040-8004
- **Mailing address phone:** (305) 296-8593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | ME0049975 | FL | Yes |

## Other

- **Enumeration date:** 04/23/2007
- **Last updated:** 08/22/2020