Provider Demographics
NPI:1184175630
Name:POLYCLINIC HEALTHCARE LP
Entity type:Organization
Organization Name:POLYCLINIC HEALTHCARE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GEN PTR
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-701-9135
Mailing Address - Street 1:11648 QUAIL ROOST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6550
Mailing Address - Country:US
Mailing Address - Phone:786-701-9135
Mailing Address - Fax:786-592-2874
Practice Address - Street 1:11648 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6550
Practice Address - Country:US
Practice Address - Phone:786-701-9135
Practice Address - Fax:786-592-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty