| Ebenezer Medical Center Llc | |
|
646 W Palm Dr Homestead FL 33034-3208 | |
| (305) 330-5393 | |
| (305) 773-0220 |
| Full Name | Ebenezer Medical Center Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 646 W Palm Dr, Homestead, Florida |
| Authorized Official Name and Position | Rene Eladio Disotuar Abad (PRESIDENT) |
| Authorized Official Contact | 3053305393 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebenezer Medical Center Llc 646 W Palm Dr Homestead FL 33034-3208 Ph: (305) 330-5393 | Ebenezer Medical Center Llc 646 W Palm Dr Homestead FL 33034-3208 Ph: (305) 330-5393 |
| NPI Number | 1134642465 |
|---|---|
| Provider Enumeration Date | 07/18/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134642465 | NPI | - | NPPES |
| 010733300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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