Organization
KEY WEST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Depoo Hospital, Key West HMA Physician Management LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
1200 KENNEDY DR STE 1031, KEY WEST, FL 33040-4023
(305) 292-5877
(305) 292-5862
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
07/23/2021
Last updated
03/16/2022
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