| Banyan Community Health Center, Inc. | |
|
10720 Caribbean Blvd Suite 420 Cutler Bay FL 33189-1218 | |
| (786) 293-9544 | |
| Not Available |
| Full Name | Banyan Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 10720 Caribbean Blvd, Cutler Bay, Florida |
| Authorized Official Name and Position | Vincent Carrodeguas (CEO) |
| Authorized Official Contact | 3053986100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banyan Community Health Center, Inc. 6100 Blue Lagoon Dr Suite 400 Miami FL 33126-2079 Ph: (305) 398-6100 | Banyan Community Health Center, Inc. 10720 Caribbean Blvd Suite 420 Cutler Bay FL 33189-1218 Ph: (786) 293-9544 |
| NPI Number | 1205219003 |
|---|---|
| Provider Enumeration Date | 06/30/2015 |
| Last Update Date | 04/18/2022 |
| Certification Date | 04/18/2022 |
| Medicare PECOS PAC ID | 0547410011 |
|---|---|
| Medicare Enrollment ID | O20190806000167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205219003 | NPI | - | NPPES |
| 012558504 | Medicaid | FL | |
| 013881908 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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