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490 Opa Locka Blvd Ste 100 Opa Locka FL 33054-3563 | |
| (305) 637-6400 | |
| (305) 636-5155 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 490 Opa Locka Blvd Ste 100, Opa Locka, Florida |
| Authorized Official Name and Position | Ryan R Hawkins (PRESIDENT/CEO) |
| Authorized Official Contact | 3058051700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5607 Nw 27th Ave Suite 1 Miami FL 33142-2826 Ph: (305) 637-6400 | 490 Opa Locka Blvd Ste 100 Opa Locka FL 33054-3563 Ph: (305) 637-6400 |
| NPI Number | 1518337880 |
|---|---|
| Provider Enumeration Date | 09/30/2015 |
| Last Update Date | 11/26/2024 |
| Medicare PECOS PAC ID | 2961486733 |
|---|---|
| Medicare Enrollment ID | O20151222000914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518337880 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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