Provider Demographics
NPI:1720150584
Name:SOUTH MIAMI MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTH MIAMI MEDICAL CENTER
Other - Org Name:RADIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-698-3880
Mailing Address - Street 1:4369 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7628
Mailing Address - Country:US
Mailing Address - Phone:305-698-3880
Mailing Address - Fax:305-698-3833
Practice Address - Street 1:4369 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7628
Practice Address - Country:US
Practice Address - Phone:305-698-3880
Practice Address - Fax:305-698-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL569012-9302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
FLF99919Medicare UPIN
FL26536FMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID