Provider Demographics
NPI:1083166185
Name:SOCORRO'S MEDICAL CENTER CORP.
Entity Type:Organization
Organization Name:SOCORRO'S MEDICAL CENTER CORP.
Other - Org Name:FLORIDA HEALTH SOLUTION CENTER, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES./ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:P
Authorized Official - Last Name:SOCORRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-269-2004
Mailing Address - Street 1:7350 NW 7 ST.
Mailing Address - Street 2:SUITE #204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2932
Mailing Address - Country:US
Mailing Address - Phone:305-269-2004
Mailing Address - Fax:305-269-2080
Practice Address - Street 1:7350 NW 7 ST.
Practice Address - Street 2:SUITE #113
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2932
Practice Address - Country:US
Practice Address - Phone:305-269-2020
Practice Address - Fax:305-269-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2082065OtherCLIA CERTIFICATE OF WAIVER