Provider Demographics
NPI:1568851921
Name:FIVE STAR MEDICAL CENTER, COPR
Entity Type:Organization
Organization Name:FIVE STAR MEDICAL CENTER, COPR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-496-5320
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-674-2242
Mailing Address - Fax:305-674-2243
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 900
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-674-2242
Practice Address - Fax:305-674-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty