Provider Demographics
NPI:1659324184
Name:FACILITY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:FACILITY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-388-5887
Mailing Address - Street 1:701 NW 57TH AVE
Mailing Address - Street 2:SUITE # 235
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2072
Mailing Address - Country:US
Mailing Address - Phone:786-388-5887
Mailing Address - Fax:786-388-5432
Practice Address - Street 1:701 NW 57TH AVE
Practice Address - Street 2:SUITE # 235
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2072
Practice Address - Country:US
Practice Address - Phone:786-388-5887
Practice Address - Fax:786-388-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9546Medicare ID - Type Unspecified