Provider Demographics
NPI:1114294097
Name:CAREVANTAGE MEDICAL CENTERS OF MIAMI AT CIVIC CENTER, LLC
Entity Type:Organization
Organization Name:CAREVANTAGE MEDICAL CENTERS OF MIAMI AT CIVIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-324-7900
Mailing Address - Street 1:1433 NW 13TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2607
Mailing Address - Country:US
Mailing Address - Phone:305-324-7900
Mailing Address - Fax:
Practice Address - Street 1:1433 NW 13TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2607
Practice Address - Country:US
Practice Address - Phone:305-324-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty