| St. John Clinic Medical Center | |
|
161 Nw 29th St Miami FL 33127-3929 | |
| (305) 576-0231 | |
| (305) 573-1458 |
| Full Name | St. John Clinic Medical Center |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 161 Nw 29th St, Miami, Florida |
| Authorized Official Name and Position | Reynaldo Cruz (CEO) |
| Authorized Official Contact | 3055760231 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. John Clinic Medical Center 161 Nw 29th St Miami FL 33127-3929 Ph: (305) 576-0231 | St. John Clinic Medical Center 161 Nw 29th St Miami FL 33127-3929 Ph: (305) 576-0231 |
| NPI Number | 1760470652 |
|---|---|
| Provider Enumeration Date | 10/13/2005 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760470652 | NPI | - | NPPES |
| 4624 | Other | FL | TOTAL HEALTH CHOICE |
| 060387200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Florida) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (Florida) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (Florida) | Secondary |
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