Provider Demographics
NPI:1083042493
Name:8TH STREET MEDICAL CENTER INC
Entity Type:Organization
Organization Name:8TH STREET MEDICAL CENTER INC
Other - Org Name:8TH STREET MEDICAL PLAZA INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MATUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-266-0600
Mailing Address - Street 1:9600 SW 8TH ST STE 18
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2947
Mailing Address - Country:US
Mailing Address - Phone:305-264-3894
Mailing Address - Fax:305-264-7501
Practice Address - Street 1:9600 SW 8TH ST STE 18
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2947
Practice Address - Country:US
Practice Address - Phone:305-266-0600
Practice Address - Fax:305-266-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014534200Medicaid