| Azure Medical Center Llc | |
|
12963 W Okeechobee Rd Ste 1 Hialeah Gardens FL 33018-6055 | |
| (786) 536-9329 | |
| Not Available |
| Full Name | Azure Medical Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 12963 W Okeechobee Rd Ste 1, Hialeah Gardens, Florida |
| Authorized Official Name and Position | Yadira Cardentey (PRESIDENT/OWNER) |
| Authorized Official Contact | 7865369329 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Azure Medical Center Llc 12963 W Okeechobee Rd Ste 1 Hialeah Gardens FL 33018-6055 Ph: (786) 536-9329 | Azure Medical Center Llc 12963 W Okeechobee Rd Ste 1 Hialeah Gardens FL 33018-6055 Ph: (786) 536-9329 |
| NPI Number | 1508459157 |
|---|---|
| Provider Enumeration Date | 02/15/2021 |
| Last Update Date | 01/17/2024 |
| Medicare PECOS PAC ID | 6901205137 |
|---|---|
| Medicare Enrollment ID | O20210520001422 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508459157 | NPI | - | NPPES |
| 109727500 | Medicaid | FL |
| Provider Name | Adam Evans |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1417101411 PECOS PAC ID: 8921263112 Enrollment ID: I20160122001076 |
| Provider Name | Eric Rafael Campillo-juig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205039005 PECOS PAC ID: 6901173566 Enrollment ID: I20171220002705 |
| Provider Name | Tae Y Kim |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1962906487 PECOS PAC ID: 7517368798 Enrollment ID: I20210624003411 |
| Provider Name | Yanelis M Bustaque Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982130506 PECOS PAC ID: 2961876339 Enrollment ID: I20230327000908 |
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