Provider Demographics
NPI:1184040560
Name:SMALL HOSPITAL INNOVATIONS LLC
Entity type:Organization
Organization Name:SMALL HOSPITAL INNOVATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:786-457-4900
Mailing Address - Street 1:2727 NE 14TH ST
Mailing Address - Street 2:116
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3595
Mailing Address - Country:US
Mailing Address - Phone:786-457-4900
Mailing Address - Fax:
Practice Address - Street 1:524 W SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3514
Practice Address - Country:US
Practice Address - Phone:954-615-7179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7985208M00000X, 207P00000X
207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1184040560Medicaid
FL25846890Medicaid
FL1245210756Medicare UPIN