Provider Demographics
NPI:1578039764
Name:MIAMI CHILDRENS HEALTH PLAN
Entity Type:Organization
Organization Name:MIAMI CHILDRENS HEALTH PLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-624-2668
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:786-624-2668
Mailing Address - Fax:
Practice Address - Street 1:5775 BLUE LAGOON DR STE 230
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-7012
Practice Address - Country:US
Practice Address - Phone:786-624-2668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization