Provider Demographics
NPI:1700822749
Name:L C MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:L C MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-244-2546
Mailing Address - Street 1:13875 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7514
Mailing Address - Country:US
Mailing Address - Phone:305-244-2546
Mailing Address - Fax:305-368-6870
Practice Address - Street 1:7000 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5154
Practice Address - Country:US
Practice Address - Phone:305-362-6868
Practice Address - Fax:305-362-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 92214261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL134868Medicare UPIN
FLU5143AMedicare ID - Type Unspecified