Provider Demographics
NPI:1083946784
Name:IVETMAR MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:IVETMAR MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-366-3720
Mailing Address - Street 1:7821 CORAL WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7821 CORAL WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6542
Practice Address - Country:US
Practice Address - Phone:786-366-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID