Provider Demographics
NPI:1376846204
Name:UNIVERSITY HEALTH CARE HOMESTEAD, INC.
Entity Type:Organization
Organization Name:UNIVERSITY HEALTH CARE HOMESTEAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-207-4443
Mailing Address - Street 1:17 NE 9TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4611
Mailing Address - Country:US
Mailing Address - Phone:305-207-4443
Mailing Address - Fax:305-207-4442
Practice Address - Street 1:17 NE 9TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4611
Practice Address - Country:US
Practice Address - Phone:305-207-4443
Practice Address - Fax:305-207-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty