Provider Demographics
NPI:1497102685
Name:ADVANCED MEDICAL CENTER GROUP LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL CENTER GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-704-7121
Mailing Address - Street 1:1350 SW 57TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5775
Mailing Address - Country:US
Mailing Address - Phone:305-704-7121
Mailing Address - Fax:305-636-4670
Practice Address - Street 1:1350 SW 57TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5775
Practice Address - Country:US
Practice Address - Phone:305-704-7121
Practice Address - Fax:305-636-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty