1568578367 NPI number — PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

Table of content: (NPI 1568578367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568578367 NPI number — PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
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:
JACKSON MEMORIAL HOSPITAL OUTPATIENT PHARMACY
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:
1568578367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12493
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:
33101-2493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-585-5315
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 NW 17TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-585-5890
Provider Business Practice Location Address Fax Number:
305-585-0088
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KNIGHT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
T
Authorized Official Title or Position:
EVP CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
305-585-7979

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH0008215 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109498001 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2011957 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 109498000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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