Provider Demographics
NPI:1578179883
Name:CENTRUM MEDICAL CENTER OF CORAL SPRINGS
Entity Type:Organization
Organization Name:CENTRUM MEDICAL CENTER OF CORAL SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGREDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-266-2929
Mailing Address - Street 1:9250 NW 36TH ST STE 420
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2775
Mailing Address - Country:US
Mailing Address - Phone:305-266-2929
Mailing Address - Fax:
Practice Address - Street 1:1801 N UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6003
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty