Provider Demographics
NPI:1760928923
Name:USCG CLINIC AIR STATION MIAMI
Entity Type:Organization
Organization Name:USCG CLINIC AIR STATION MIAMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HSWL SC
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-628-4363
Mailing Address - Street 1:14750 NW 44TH CT
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2304
Mailing Address - Country:US
Mailing Address - Phone:757-628-4363
Mailing Address - Fax:
Practice Address - Street 1:14750 NW 44TH CT
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2304
Practice Address - Country:US
Practice Address - Phone:757-628-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient