Provider Demographics
NPI:1093255820
Name:SOUTH FLORIDA INTEGRATIVE HEALTH CENTER LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA INTEGRATIVE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DURRELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANDWERGER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-799-1263
Mailing Address - Street 1:9225 COLLINS AVE
Mailing Address - Street 2:PENTHOUSE G
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-3046
Mailing Address - Country:US
Mailing Address - Phone:305-799-1263
Mailing Address - Fax:
Practice Address - Street 1:1111 KANE CONCOURSE
Practice Address - Street 2:511
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2029
Practice Address - Country:US
Practice Address - Phone:305-864-8607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center