Provider Demographics
NPI:1841787926
Name:EVERGLADES MEDICAL HEALTH CENTER LLC
Entity Type:Organization
Organization Name:EVERGLADES MEDICAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:863-610-0410
Mailing Address - Street 1:2157 BACOM POINT RD
Mailing Address - Street 2:
Mailing Address - City:PAHOKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33476-2623
Mailing Address - Country:US
Mailing Address - Phone:863-610-0410
Mailing Address - Fax:888-353-4226
Practice Address - Street 1:485 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PAHOKEE
Practice Address - State:FL
Practice Address - Zip Code:33476-2405
Practice Address - Country:US
Practice Address - Phone:561-768-6167
Practice Address - Fax:888-353-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service