| Southern Winds Hospital Llc | |
|
4225 W 20th Ave Hialeah FL 33012-5826 | |
| (305) 558-9700 | |
| Not Available |
| Full Name | Southern Winds Hospital Llc |
|---|---|
| Speciality | General Practice |
| Location | 4225 W 20th Ave, Hialeah, Florida |
| Authorized Official Name and Position | Andrew Brick-turin (CFO) |
| Authorized Official Contact | 3055589700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Winds Hospital Llc 10800 Biscayne Blvd Ste 600 Miami FL 33161-7499 Ph: (305) 864-9191 | Southern Winds Hospital Llc 4225 W 20th Ave Hialeah FL 33012-5826 Ph: (305) 558-9700 |
| NPI Number | 1871176222 |
|---|---|
| Provider Enumeration Date | 05/04/2021 |
| Last Update Date | 05/04/2021 |
| Certification Date | 04/28/2021 |
| Medicare PECOS PAC ID | 2264767565 |
|---|---|
| Medicare Enrollment ID | O20220805000123 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871176222 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Irina Licea |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649454091 PECOS PAC ID: 5890879126 Enrollment ID: I20100224000979 |
| Provider Name | Raul J Roa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316110653 PECOS PAC ID: 0143364448 Enrollment ID: I20100224000989 |
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