Provider Demographics
NPI:1427007343
Name:HIALEAH DRIVE MEDCIAL CENTER,LLC
Entity Type:Organization
Organization Name:HIALEAH DRIVE MEDCIAL CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIRIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-889-6665
Mailing Address - Street 1:461 HIALEAH DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5346
Mailing Address - Country:US
Mailing Address - Phone:305-889-6665
Mailing Address - Fax:
Practice Address - Street 1:461 HIALEAH DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5346
Practice Address - Country:US
Practice Address - Phone:305-889-6665
Practice Address - Fax:305-889-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI21846Medicare UPIN
FLK6487Medicare ID - Type UnspecifiedMEDICARE PROVIDER