Provider Demographics
NPI:1063454676
Name:ELI MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ELI MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:SEBASTIAN
Authorized Official - Last Name:MUNGUIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-265-1881
Mailing Address - Street 1:5935 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5037
Mailing Address - Country:US
Mailing Address - Phone:305-265-1881
Mailing Address - Fax:
Practice Address - Street 1:5935 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5037
Practice Address - Country:US
Practice Address - Phone:305-265-1881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELI MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-11
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4733261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5818Medicare ID - Type Unspecified