Provider Demographics
NPI:1831263771
Name:PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA
Entity type:Organization
Organization Name:PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-585-8490
Mailing Address - Street 1:1951 NW 7TH AVE
Mailing Address - Street 2:SUITE 160, BOX 140
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1104
Mailing Address - Country:US
Mailing Address - Phone:305-355-5222
Mailing Address - Fax:305-355-5380
Practice Address - Street 1:1477 NW 8TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1425
Practice Address - Country:US
Practice Address - Phone:305-585-8957
Practice Address - Fax:305-585-5259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010042105Medicaid
FL100022Medicare Oscar/Certification