Provider Demographics
NPI:1043470073
Name:MEDAMAX, LLC
Entity Type:Organization
Organization Name:MEDAMAX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-733-3577
Mailing Address - Street 1:12000 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2735
Mailing Address - Country:US
Mailing Address - Phone:305-733-3577
Mailing Address - Fax:305-933-1021
Practice Address - Street 1:550 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4755
Practice Address - Country:US
Practice Address - Phone:305-733-3571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL408555-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center