Provider Demographics
NPI:1881722320
Name:K & J MEDICAL CENTER INC
Entity type:Organization
Organization Name:K & J MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAQUIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-468-3302
Mailing Address - Street 1:3900 NW 79 AVE
Mailing Address - Street 2:SUITE 326
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6547
Mailing Address - Country:US
Mailing Address - Phone:305-468-3302
Mailing Address - Fax:305-468-3303
Practice Address - Street 1:3900 NW 79 AVE
Practice Address - Street 2:SUITE 326
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6547
Practice Address - Country:US
Practice Address - Phone:305-468-3302
Practice Address - Fax:305-468-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7010261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0013Medicare PIN