Provider Demographics
NPI: | 1467684167 |
---|---|
Name: | UNIVERSAL MEDICAL CENTER |
Entity Type: | Organization |
Organization Name: | UNIVERSAL MEDICAL CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL CENTER DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RODOLFO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MOLINA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 786-237-3070 |
Mailing Address - Street 1: | 12376 QUAIL ROOST DR |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33177-4974 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 786-237-3070 |
Mailing Address - Fax: | 786-237-3071 |
Practice Address - Street 1: | 12376 QUAIL ROOST DR |
Practice Address - Street 2: | |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33177-4974 |
Practice Address - Country: | US |
Practice Address - Phone: | 786-237-3070 |
Practice Address - Fax: | 786-237-3071 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-08-13 |
Last Update Date: | 2009-08-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | HCC8370 | 302R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 302R00000X | Managed Care Organizations | Health Maintenance Organization |