Provider Demographics
NPI:1811946312
Name:TAMIAMI MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:TAMIAMI MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-599-1545
Mailing Address - Street 1:1150 NW 72ND AVE
Mailing Address - Street 2:SUITE # 577
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1936
Mailing Address - Country:US
Mailing Address - Phone:305-599-1545
Mailing Address - Fax:305-599-9928
Practice Address - Street 1:1150 NW 72ND AVE
Practice Address - Street 2:SUITE # 577
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1936
Practice Address - Country:US
Practice Address - Phone:305-599-1545
Practice Address - Fax:305-599-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684893Medicare ID - Type UnspecifiedPROVIDER NUMBER