Provider Demographics
NPI:1659505881
Name:CUTLER RIDGE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:CUTLER RIDGE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGMR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-238-2961
Mailing Address - Street 1:10700 CARIBBEAN BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1232
Mailing Address - Country:US
Mailing Address - Phone:305-238-2961
Mailing Address - Fax:305-238-2618
Practice Address - Street 1:10700 CARIBBEAN BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1232
Practice Address - Country:US
Practice Address - Phone:305-238-2961
Practice Address - Fax:305-238-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty