Provider Demographics
NPI:1932211299
Name:MEDISON COMPLETE HEALTH CARE CO
Entity Type:Organization
Organization Name:MEDISON COMPLETE HEALTH CARE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YOANKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-828-2301
Mailing Address - Street 1:6900 W 32ND AVE
Mailing Address - Street 2:STE 10
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5227
Mailing Address - Country:US
Mailing Address - Phone:305-828-2301
Mailing Address - Fax:305-828-2303
Practice Address - Street 1:6900 W 32ND AVE
Practice Address - Street 2:STE 10
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5227
Practice Address - Country:US
Practice Address - Phone:305-828-2301
Practice Address - Fax:305-828-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4463261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5835Medicare PIN