Provider Demographics
NPI:1467003889
Name:SOUTH DADE PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:SOUTH DADE PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULLINIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-758-3135
Mailing Address - Street 1:14750 NW 77TH CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1507
Mailing Address - Country:US
Mailing Address - Phone:786-758-3165
Mailing Address - Fax:
Practice Address - Street 1:5901 SW 74TH ST STE 205
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5150
Practice Address - Country:US
Practice Address - Phone:305-666-8691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAREMEDICA HEALTH PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-26
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site