Provider Demographics
NPI:1255834594
Name:MEDISUN 62 MEDICAL CENTER LLC
Entity type:Organization
Organization Name:MEDISUN 62 MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLOETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-350-5583
Mailing Address - Street 1:180 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-4543
Mailing Address - Country:US
Mailing Address - Phone:786-360-5625
Mailing Address - Fax:
Practice Address - Street 1:180 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-4543
Practice Address - Country:US
Practice Address - Phone:786-360-5625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center