Provider Demographics
NPI:1689771958
Name:SOCIAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:SOCIAL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-1599
Mailing Address - Street 1:2140 W FLAGLER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-5600
Mailing Address - Country:US
Mailing Address - Phone:305-649-1599
Mailing Address - Fax:305-649-5935
Practice Address - Street 1:2140 W FLAGLER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-5600
Practice Address - Country:US
Practice Address - Phone:305-649-1599
Practice Address - Fax:305-649-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4982Medicare ID - Type Unspecified