Provider Demographics
NPI:1598923450
Name:PANAMERICAN HEALTH CENTER INC
Entity Type:Organization
Organization Name:PANAMERICAN HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:305-567-0060
Mailing Address - Street 1:4750 NW 7TH STREET
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2253
Mailing Address - Country:US
Mailing Address - Phone:305-567-0060
Mailing Address - Fax:305-567-0065
Practice Address - Street 1:4750 NW 7TH STREET
Practice Address - Street 2:SUITE 13
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2253
Practice Address - Country:US
Practice Address - Phone:305-567-0060
Practice Address - Fax:305-567-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8930111N00000X
FLHCC6049208D00000X
FLACN 223208D00000X
FLACN 316208D00000X
FLSI 6372355S0801X
FLCI 415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8291AMedicaid