Provider Demographics
NPI:1225067010
Name:MILLENIUM MEDICAL CENTER INC
Entity Type:Organization
Organization Name:MILLENIUM MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-227-2572
Mailing Address - Street 1:8660 W FLAGLER ST
Mailing Address - Street 2:202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2031
Mailing Address - Country:US
Mailing Address - Phone:305-227-2572
Mailing Address - Fax:305-227-2573
Practice Address - Street 1:8660 W FLAGLER ST
Practice Address - Street 2:102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:31144-2031
Practice Address - Country:US
Practice Address - Phone:305-227-2572
Practice Address - Fax:305-227-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN
FL683243Medicare Oscar/Certification