Provider Demographics
NPI:1043395460
Name:PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Entity Type:Organization
Organization Name:PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Other - Org Name:PHT/JHS-JMH HOSPITALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-585-7137
Mailing Address - Street 1:1500 NW 12TH AVE
Mailing Address - Street 2:JACKSON MEDICAL TOWERS SUITE 1129
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1051
Mailing Address - Country:US
Mailing Address - Phone:305-585-8957
Mailing Address - Fax:585-585-5259
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-8957
Practice Address - Fax:305-585-5259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHT OF DADE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272051500Medicaid