Provider Demographics
NPI:1710376389
Name:EARLY TIME MEDICAL CENTER INC
Entity Type:Organization
Organization Name:EARLY TIME MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-762-3907
Mailing Address - Street 1:1275 W 47TH PL STE 305
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3447
Mailing Address - Country:US
Mailing Address - Phone:786-409-2495
Mailing Address - Fax:786-409-2472
Practice Address - Street 1:1275 W 47TH PL STE 305
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3447
Practice Address - Country:US
Practice Address - Phone:786-409-2495
Practice Address - Fax:786-409-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2017-01-19
Deactivation Date:2016-12-07
Deactivation Code:
Reactivation Date:2017-01-19
Provider Licenses
StateLicense IDTaxonomies
FLME55442261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service