Provider Demographics
NPI:1427370436
Name:AIRPORT MD-MIAMI LLC
Entity Type:Organization
Organization Name:AIRPORT MD-MIAMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-602-6996
Mailing Address - Street 1:5741 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3307
Mailing Address - Country:US
Mailing Address - Phone:800-700-0278
Mailing Address - Fax:251-666-8398
Practice Address - Street 1:4200 NW 21ST STREET
Practice Address - Street 2:MIAMI INTERNATIONAL AIRPORT-CONCOURSE H
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142
Practice Address - Country:US
Practice Address - Phone:305-869-4075
Practice Address - Fax:305-869-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-8015240864-1261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care