Provider Demographics
NPI:1003192584
Name:MAGIC SPOT MEDICAL CENTER
Entity Type:Organization
Organization Name:MAGIC SPOT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YINEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-567-2797
Mailing Address - Street 1:145 MADEIRA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4520
Mailing Address - Country:US
Mailing Address - Phone:305-567-2797
Mailing Address - Fax:305-567-9001
Practice Address - Street 1:145 MADEIRA AVE STE 202
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4520
Practice Address - Country:US
Practice Address - Phone:305-567-2797
Practice Address - Fax:305-567-9001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGIC SPOT MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center