Provider Demographics
NPI:1093718132
Name:SOUTH MIAMI PAIN & REHAB CENTER, INC
Entity Type:Organization
Organization Name:SOUTH MIAMI PAIN & REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-819-7770
Mailing Address - Street 1:468 W 51ST PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3620
Mailing Address - Country:US
Mailing Address - Phone:305-819-7770
Mailing Address - Fax:954-473-0211
Practice Address - Street 1:468 W 51ST PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3620
Practice Address - Country:US
Practice Address - Phone:305-819-7770
Practice Address - Fax:954-473-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105775Medicare Oscar/Certification