Provider Demographics
NPI:1689008302
Name:UNITED MEDICAL SPECIALTIES INC.
Entity Type:Organization
Organization Name:UNITED MEDICAL SPECIALTIES INC.
Other - Org Name:UNITED MEDICAL SPECIALTIES INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-444-1213
Mailing Address - Street 1:6705 S RED RD STE 522
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3649
Mailing Address - Country:US
Mailing Address - Phone:305-444-1213
Mailing Address - Fax:305-444-1216
Practice Address - Street 1:6705 S RED RD STE 522
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3649
Practice Address - Country:US
Practice Address - Phone:305-444-1213
Practice Address - Fax:305-444-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101122174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568652048OtherINDIVIDUAL NPI
1568652048OtherINDIVIDUAL NPI