Provider Demographics
NPI:1043209786
Name:IFA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:IFA MEDICAL CENTER INC
Other - Org Name:UNIVERSITY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-207-4443
Mailing Address - Street 1:1695 SW 107TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7344
Mailing Address - Country:US
Mailing Address - Phone:305-207-4443
Mailing Address - Fax:305-207-4442
Practice Address - Street 1:1695 SW 107TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7344
Practice Address - Country:US
Practice Address - Phone:305-207-4443
Practice Address - Fax:305-207-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-15
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3352Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
FL684889Medicare Oscar/Certification
FLQ0104Medicare PIN