Provider Demographics
NPI:1568405827
Name:CARPUS MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:CARPUS MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-447-4949
Mailing Address - Street 1:6741 SW 24TH ST
Mailing Address - Street 2:SUITE 41-42
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1762
Mailing Address - Country:US
Mailing Address - Phone:305-447-4949
Mailing Address - Fax:305-263-1070
Practice Address - Street 1:475 BILTMORE WAY
Practice Address - Street 2:SUITE 309
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5755
Practice Address - Country:US
Practice Address - Phone:305-445-1139
Practice Address - Fax:305-445-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6567261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8172Medicare PIN