| Sunsouth St. Jude Health Care, Llc | |
|
8374 Pines Blvd Pembroke Pines FL 33024-6616 | |
| (954) 429-6986 | |
| (954) 429-6987 |
| Full Name | Sunsouth St. Jude Health Care, Llc |
|---|---|
| Speciality | General Practice |
| Location | 8374 Pines Blvd, Pembroke Pines, Florida |
| Authorized Official Name and Position | Carlos Arias (CEO) |
| Authorized Official Contact | 3522775305 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunsouth St. Jude Health Care, Llc 14690 Spring Hill Dr Spring Hill FL 34609-8102 Ph: () - | Sunsouth St. Jude Health Care, Llc 8374 Pines Blvd Pembroke Pines FL 33024-6616 Ph: (954) 429-6986 |
| NPI Number | 1548037807 |
|---|---|
| Provider Enumeration Date | 12/07/2023 |
| Last Update Date | 12/12/2023 |
| Medicare PECOS PAC ID | 3779929831 |
|---|---|
| Medicare Enrollment ID | O20240312000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548037807 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Yaolen Bolanos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942402045 PECOS PAC ID: 1850434788 Enrollment ID: I20100201000487 |
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