Provider Demographics
NPI:1316045792
Name:INTEGRATED DIAGNOSTIC OF SOUTH FLORIDA INC
Entity Type:Organization
Organization Name:INTEGRATED DIAGNOSTIC OF SOUTH FLORIDA INC
Other - Org Name:THE PULMONARY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-598-5551
Mailing Address - Street 1:9380 SW 72ND ST
Mailing Address - Street 2:SUITE B-238
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3276
Mailing Address - Country:US
Mailing Address - Phone:305-598-5551
Mailing Address - Fax:305-598-5516
Practice Address - Street 1:9380 SW 72ND ST
Practice Address - Street 2:SUITE B-238
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3276
Practice Address - Country:US
Practice Address - Phone:305-598-5551
Practice Address - Fax:305-598-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3828261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1043Medicare UPIN