Basic Information
| Provider Information | |||||||||
| NPI: | 1295987030 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KEITH P HUSSEY MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 681 GOODLETTE RD N | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396439767 | ||||||||
| FaxNumber: | 2396495878 | ||||||||
| Practice Location | |||||||||
| Address1: | 681 GOODLETTE RD N | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396439767 | ||||||||
| FaxNumber: | 2396495878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2008 | ||||||||
| LastUpdateDate: | 12/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | HUSSEY | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2396439767 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME46740 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 049444500 | 05 | FL | MEDICAID | 100010818 | 01 | FL | RAILROAD MEDICARE | OTHER |