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18255 Homestead Ave Perrine FL 33157-5564 | |
(305) 252-4487 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 18255 Homestead Ave, Perrine, Florida |
Authorized Official Name and Position | Jeremy David Radziewicz (CFO) |
Authorized Official Contact | 3052326047 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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10300 Sw 216th St Miami FL 33190-1003 Ph: (305) 253-5100 | 18255 Homestead Ave Perrine FL 33157-5564 Ph: (305) 252-4487 |
NPI Number | 1164685673 |
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Provider Enumeration Date | 07/03/2008 |
Last Update Date | 08/29/2024 |
Medicare PECOS PAC ID | 6507770526 |
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Medicare Enrollment ID | O20040726000662 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164685673 | NPI | - | NPPES |
053715201 | Medicaid | FL | |
029572804 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |