1053548537 NPI number — SOUTH FLORIDA FAMILY HEALTH AND RESEARCH CENTERS, LLC.

Table of content: (NPI 1053548537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053548537 NPI number — SOUTH FLORIDA FAMILY HEALTH AND RESEARCH CENTERS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FLORIDA FAMILY HEALTH AND RESEARCH CENTERS, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH FLORIDA FAMILY HEALTH & RESEARCH CENTERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053548537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13500 SW 88TH ST STE 175
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33186-1528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-387-0081
Provider Business Mailing Address Fax Number:
305-387-0053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13500 SW 88TH STR
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33186-1528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-387-0051
Provider Business Practice Location Address Fax Number:
305-387-0053
Provider Enumeration Date:
06/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
305-387-0081

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  HCC8585 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X , with the licence number: HCC8585 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , with the licence number: HCC8585 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: HCC8585 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1100X , with the licence number: HCC8585 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1000X , with the licence number: HCC8585 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101124900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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