Provider Demographics
NPI:1740608173
Name:DOCTORS MEDICAL CENTER INC
Entity Type:Organization
Organization Name:DOCTORS MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:VENTURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-685-5688
Mailing Address - Street 1:1200 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5936
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:786-693-7731
Practice Address - Street 1:7900 NW 27TH AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4909
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063667305Medicaid