Provider Demographics
NPI:1649676479
Name:CENTURY MEDICAL GROUP, CORP
Entity type:Organization
Organization Name:CENTURY MEDICAL GROUP, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CIRIA
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-733-4301
Mailing Address - Street 1:11300 NW 87TH CT
Mailing Address - Street 2:SUITE #141
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4586
Mailing Address - Country:US
Mailing Address - Phone:305-392-0257
Mailing Address - Fax:786-360-2989
Practice Address - Street 1:11300 NW 87TH CT
Practice Address - Street 2:SUITE #141
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4586
Practice Address - Country:US
Practice Address - Phone:305-392-0257
Practice Address - Fax:786-360-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBL16276208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty