Provider Demographics
NPI:1275606832
Name:INTERAMERICAN MEDICAL CENTER GROUP LLC
Entity Type:Organization
Organization Name:INTERAMERICAN MEDICAL CENTER GROUP LLC
Other - Org Name:IMC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-8100
Mailing Address - Street 1:1000 NW 57TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3284
Mailing Address - Country:US
Mailing Address - Phone:305-649-8100
Mailing Address - Fax:305-649-8778
Practice Address - Street 1:1435 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4506
Practice Address - Country:US
Practice Address - Phone:305-246-3864
Practice Address - Fax:305-246-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEU039BOtherPTAN
FL008705007Medicaid