Provider Demographics
NPI:1023199031
Name:BENTLY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:BENTLY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-631-1080
Mailing Address - Street 1:42 NW 27TH AVE
Mailing Address - Street 2:SUITE 42
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5127
Mailing Address - Country:US
Mailing Address - Phone:305-631-1080
Mailing Address - Fax:305-631-1180
Practice Address - Street 1:424 NW 27TH AVE
Practice Address - Street 2:SUITE 424
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5127
Practice Address - Country:US
Practice Address - Phone:305-631-1080
Practice Address - Fax:305-631-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL588895-4261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center