Provider Demographics
NPI:1508459157
Name:AZURE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:AZURE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENTEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-536-9329
Mailing Address - Street 1:12963 W OKEECHOBEE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6055
Mailing Address - Country:US
Mailing Address - Phone:786-536-9329
Mailing Address - Fax:
Practice Address - Street 1:12963 W OKEECHOBEE RD STE 1
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-6055
Practice Address - Country:US
Practice Address - Phone:786-536-9329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109727500Medicaid