| Eternity Medical Group Corp | |
|
900 Sw 8th St Ste C1 Miami FL 33130-3756 | |
| (786) 332-3136 | |
| (305) 726-0013 |
| Full Name | Eternity Medical Group Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 900 Sw 8th St Ste C1, Miami, Florida |
| Authorized Official Name and Position | Luis Aguilar (OWNER/PRESIDENT) |
| Authorized Official Contact | 7863323136 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eternity Medical Group Corp 900 Sw 8th St Ste C1 Miami FL 33130-3756 Ph: (786) 332-3136 | Eternity Medical Group Corp 900 Sw 8th St Ste C1 Miami FL 33130-3756 Ph: (786) 332-3136 |
| NPI Number | 1083216022 |
|---|---|
| Provider Enumeration Date | 11/13/2020 |
| Last Update Date | 07/16/2024 |
| Certification Date | 07/16/2024 |
| Medicare PECOS PAC ID | 9830590363 |
|---|---|
| Medicare Enrollment ID | O20210622001545 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083216022 | NPI | - | NPPES |
| 13052 | Other | FL | HEALTH CARE CLINIC STANDARD LICENSE |
| 108835400 | Medicaid | FL |
| Provider Name | Luis M Campillo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922054352 PECOS PAC ID: 7113812413 Enrollment ID: I20040217000093 |
| Provider Name | Karen Romero |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275185613 PECOS PAC ID: 3779929989 Enrollment ID: I20240311001808 |
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