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6601 Sw 62nd Ave South Miami FL 33143-3300 | |
| (305) 669-6900 | |
| (305) 669-6907 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 6601 Sw 62nd Ave, South Miami, Florida |
| Authorized Official Name and Position | Mark T Knight (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3055857979 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 12493 Miami FL 33101-2493 Ph: (786) 466-8080 | 6601 Sw 62nd Ave South Miami FL 33143-3300 Ph: (305) 669-6900 |
| NPI Number | 1679648943 |
|---|---|
| Provider Enumeration Date | 11/22/2006 |
| Last Update Date | 04/06/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679648943 | NPI | - | NPPES |
| 010042119 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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