Provider Demographics
NPI:1033155643
Name:BANYAN COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:BANYAN COMMUNITY HEALTH CENTER INC
Other - Org Name:BANYAN HEALTH SYSTEMS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRODEGUAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-398-6100
Mailing Address - Street 1:3850 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1604
Mailing Address - Country:US
Mailing Address - Phone:305-442-1732
Mailing Address - Fax:305-442-7175
Practice Address - Street 1:3850 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1604
Practice Address - Country:US
Practice Address - Phone:305-442-1732
Practice Address - Fax:305-442-7175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X, 3336L0003X
FLPH95793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109574900Medicaid
FL109574900Medicaid
2009451OtherPK