Provider Demographics
NPI:1154688174
Name:MIAMI RESCUE MISSION CLINIC, INC
Entity Type:Organization
Organization Name:MIAMI RESCUE MISSION CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-606-5317
Mailing Address - Street 1:2015 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-4901
Mailing Address - Country:US
Mailing Address - Phone:305-571-2273
Mailing Address - Fax:305-572-2025
Practice Address - Street 1:2015 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-4901
Practice Address - Country:US
Practice Address - Phone:305-571-2273
Practice Address - Fax:305-572-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3622261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3537400Medicaid
FL3537400Medicaid
FLP05571Medicare UPIN