Provider Demographics
NPI:1194364497
Name:WEST MIAMI MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:WEST MIAMI MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:CAMEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-721-0940
Mailing Address - Street 1:1350 SW 57TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5775
Mailing Address - Country:US
Mailing Address - Phone:305-721-0940
Mailing Address - Fax:305-614-3889
Practice Address - Street 1:1350 SW 57TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5775
Practice Address - Country:US
Practice Address - Phone:305-614-3002
Practice Address - Fax:305-614-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty