Provider Demographics
NPI:1851407522
Name:PALMETTO MEDICAL CENTER
Entity Type:Organization
Organization Name:PALMETTO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-874-2258
Mailing Address - Street 1:6501 NW 36TH ST
Mailing Address - Street 2:#414
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6959
Mailing Address - Country:US
Mailing Address - Phone:305-874-2258
Mailing Address - Fax:305-874-2259
Practice Address - Street 1:6501 NW 36TH ST
Practice Address - Street 2:#414
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6959
Practice Address - Country:US
Practice Address - Phone:305-874-2258
Practice Address - Fax:305-874-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6911208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9794Medicare ID - Type Unspecified