Provider Demographics
NPI:1578596722
Name:BISCAYNE MEDICAL CENTER
Entity Type:Organization
Organization Name:BISCAYNE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-983-1557
Mailing Address - Street 1:6966 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3800
Mailing Address - Country:US
Mailing Address - Phone:954-983-1557
Mailing Address - Fax:954-983-5528
Practice Address - Street 1:6966 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3800
Practice Address - Country:US
Practice Address - Phone:954-983-1557
Practice Address - Fax:954-983-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3818208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39488Medicare ID - Type UnspecifiedMEDICARE PROVIDER