Provider Demographics
NPI:1689386377
Name:EPIC MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:EPIC MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIMES
Authorized Official - Suffix:
Authorized Official - Credentials:CH
Authorized Official - Phone:305-244-5883
Mailing Address - Street 1:12277 SW 130TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6218
Mailing Address - Country:US
Mailing Address - Phone:305-244-5883
Mailing Address - Fax:305-203-0546
Practice Address - Street 1:12277 SW 130TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6218
Practice Address - Country:US
Practice Address - Phone:305-244-5883
Practice Address - Fax:305-203-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH8107OtherMEDICAL LICENSE