Provider Demographics
NPI:1720294911
Name:MEDICAL CENTER GROUP OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:MEDICAL CENTER GROUP OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-264-9636
Mailing Address - Street 1:7360 CORAL WAY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1498
Mailing Address - Country:US
Mailing Address - Phone:305-264-9636
Mailing Address - Fax:305-269-3443
Practice Address - Street 1:7360 CORAL WAY
Practice Address - Street 2:SUITE 11
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1498
Practice Address - Country:US
Practice Address - Phone:305-264-9636
Practice Address - Fax:305-269-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6174940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID