Provider Demographics
NPI:1164690384
Name:MEDICAL SERVICE CENTER OF FLORIDA INC
Entity Type:Organization
Organization Name:MEDICAL SERVICE CENTER OF FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:305-551-7887
Mailing Address - Street 1:8410 W FLAGLER ST
Mailing Address - Street 2:SUITE 210 B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2092
Mailing Address - Country:US
Mailing Address - Phone:305-551-7887
Mailing Address - Fax:305-551-8431
Practice Address - Street 1:8410 W FLAGLER ST
Practice Address - Street 2:SUITE 210 B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2092
Practice Address - Country:US
Practice Address - Phone:305-551-7887
Practice Address - Fax:305-551-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
FLHCC5931320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty