| Key Bridge, Inc. | |
|
1111 12th St Suite 212 Key West FL 33040-4088 | |
| (305) 783-3677 | |
| Not Available |
| Full Name | Key Bridge, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1111 12th St, Key West, Florida |
| Authorized Official Name and Position | Michael Rogers (PRESIDENT) |
| Authorized Official Contact | 3057833677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Key Bridge, Inc. 1111 12th St Suite 212 Key West FL 33040-4088 Ph: (305) 783-3677 | Key Bridge, Inc. 1111 12th St Suite 212 Key West FL 33040-4088 Ph: (305) 783-3677 |
| NPI Number | 1306381215 |
|---|---|
| Provider Enumeration Date | 12/31/2016 |
| Last Update Date | 08/23/2022 |
| Certification Date | 08/23/2022 |
| Medicare PECOS PAC ID | 2769746452 |
|---|---|
| Medicare Enrollment ID | O20180504001001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306381215 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | IMH14005 (Florida) | Primary |
| Provider Name | Andrew R Monteiro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497741169 PECOS PAC ID: 4880726611 Enrollment ID: I20161010001525 |
| Provider Name | Elaine Mchale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720487432 PECOS PAC ID: 9436414836 Enrollment ID: I20180606002129 |
| Provider Name | Joanne Louise Avis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972113918 PECOS PAC ID: 6305257684 Enrollment ID: I20201117001317 |
| Provider Name | Keyeriashon Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801271713 PECOS PAC ID: 9032492343 Enrollment ID: I20220913001292 |
| Provider Name | Heden Presendieu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1972921781 PECOS PAC ID: 7416171202 Enrollment ID: I20230809000481 |
| Provider Name | Michael Jack Rogers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760892038 PECOS PAC ID: 5193002913 Enrollment ID: I20231116003015 |
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