| Organization Name: | OLD TOWN COMMUNITY HEALTH CENTER |
| NPI Number: | 1548488778 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IVIS FONSECA (BILLING MANAGER) |
| Mailing Address: | 3134 Northside Dr Key West |
| State: | FL US |
| Postal Code: | 330408004 |
| Phone Number: | 3052968593 |
| Fax Number: | |
| NPI Enumeration Date: | 04/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME0049975 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |