Provider Demographics
NPI:1659633188
Name:C&C MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:C&C MEDICAL CENTER INC.
Other - Org Name:C&C MEDICAL CENTER INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MA 66278
Authorized Official - Phone:305-819-6353
Mailing Address - Street 1:7100 W 20TH AVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1811
Mailing Address - Country:US
Mailing Address - Phone:305-819-6353
Mailing Address - Fax:
Practice Address - Street 1:7100 W 20TH AVE STE 412
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1811
Practice Address - Country:US
Practice Address - Phone:305-819-6353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66278261QR0400X
261QP2000X, 261QR0200X, 261QR0400X, 291U00000X
FLPA9100767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96857OtherBCBSF