Provider Demographics
NPI:1518006923
Name:HIALEAH MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:HIALEAH MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-696-7500
Mailing Address - Street 1:555 E 25TH ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3848
Mailing Address - Country:US
Mailing Address - Phone:305-696-7500
Mailing Address - Fax:
Practice Address - Street 1:555 E 25TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3848
Practice Address - Country:US
Practice Address - Phone:305-696-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
FLAF663Medicare PIN