Provider Demographics
NPI:1376784801
Name:KENDALL FAMILY MEDICAL CENTER, CORP.
Entity Type:Organization
Organization Name:KENDALL FAMILY MEDICAL CENTER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-485-7979
Mailing Address - Street 1:11760 SW 40TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3589
Mailing Address - Country:US
Mailing Address - Phone:305-552-6969
Mailing Address - Fax:305-552-6775
Practice Address - Street 1:11760 SW 40TH ST STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3589
Practice Address - Country:US
Practice Address - Phone:305-552-6969
Practice Address - Fax:305-552-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX IDENTIFICATION NO EIN