Provider Demographics
NPI:1669690541
Name:COLONY SPRINGS MEDICAL CENTER, INC
Entity type:Organization
Organization Name:COLONY SPRINGS MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:JOHANNA
Authorized Official - Last Name:NEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-726-3721
Mailing Address - Street 1:7737 N UNIVERSITY DR
Mailing Address - Street 2:107
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2961
Mailing Address - Country:US
Mailing Address - Phone:954-720-0056
Mailing Address - Fax:954-721-4120
Practice Address - Street 1:7737 N UNIVERSITY DR
Practice Address - Street 2:107
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2961
Practice Address - Country:US
Practice Address - Phone:954-720-0056
Practice Address - Fax:954-721-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051532900Medicaid
FL39364Medicare UPIN
FL051532900Medicaid