| Great Life Medical Center, Inc | |
|
4355 W 16th Ave Ste 205b Hialeah FL 33012-7668 | |
| (786) 353-2732 | |
| (786) 353-2739 |
| Full Name | Great Life Medical Center, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4355 W 16th Ave Ste 205b, Hialeah, Florida |
| Authorized Official Name and Position | Adrian Vigil Pereira (OWNER) |
| Authorized Official Contact | 7868574952 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Life Medical Center, Inc 4355 W 16th Ave Ste 205b Hialeah FL 33012-7668 Ph: (786) 353-2732 | Great Life Medical Center, Inc 4355 W 16th Ave Ste 205b Hialeah FL 33012-7668 Ph: (786) 353-2732 |
| NPI Number | 1790376887 |
|---|---|
| Provider Enumeration Date | 02/01/2021 |
| Last Update Date | 02/01/2021 |
| Certification Date | 02/01/2021 |
| Medicare PECOS PAC ID | 1557742178 |
|---|---|
| Medicare Enrollment ID | O20220713003909 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790376887 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Sarah Hughes |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1407392194 PECOS PAC ID: 0840522108 Enrollment ID: I20191106000865 |
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