Provider Demographics
NPI:1043334162
Name:JACKSON HOSPITAL
Entity Type:Organization
Organization Name:JACKSON HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SARMIENTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-585-6262
Mailing Address - Street 1:1611 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-6262
Mailing Address - Fax:305-585-2457
Practice Address - Street 1:1033 SW 72ND AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:305-665-6798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME9057283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital