Provider Demographics
NPI:1578053070
Name:SOUTH MIAMI MEDICAL CENTER INC
Entity Type:Organization
Organization Name:SOUTH MIAMI MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROLLE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:305-807-4871
Mailing Address - Street 1:14340 SW 172ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2736
Mailing Address - Country:US
Mailing Address - Phone:305-807-4871
Mailing Address - Fax:305-675-2668
Practice Address - Street 1:10740 W FLAGLER ST STE 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4405
Practice Address - Country:US
Practice Address - Phone:305-807-4871
Practice Address - Fax:305-675-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCCOtherAHCA EXEMPT