Provider Demographics
NPI:1518355718
Name:PWS MEDICAL PA
Entity Type:Organization
Organization Name:PWS MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-901-2133
Mailing Address - Street 1:PO BOX 560275
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-0275
Mailing Address - Country:US
Mailing Address - Phone:305-901-2133
Mailing Address - Fax:
Practice Address - Street 1:8200 SW 117TH AVE
Practice Address - Street 2:#300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3856
Practice Address - Country:US
Practice Address - Phone:305-901-2133
Practice Address - Fax:305-901-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00419000Medicaid
AL559ZMedicare PIN