Provider Demographics
NPI:1609539832
Name:INTERAMERICAN MEDICAL CENTER GROUP, LLC
Entity Type:Organization
Organization Name:INTERAMERICAN MEDICAL CENTER GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YUSMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-8100
Mailing Address - Street 1:1000 NW 57TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3284
Mailing Address - Country:US
Mailing Address - Phone:305-446-8423
Mailing Address - Fax:
Practice Address - Street 1:401 CORAL WAY STE 201
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4924
Practice Address - Country:US
Practice Address - Phone:305-446-8423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERAMERICAN MEDICAL CENTER GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty