Provider Demographics
NPI:1982906442
Name:COMMUNITY HEALTH OF SOUTH FLORIDA INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH OF SOUTH FLORIDA INC
Other - Org Name:MARATHON HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRODES
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-251-4853
Mailing Address - Street 1:2805 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2239
Mailing Address - Country:US
Mailing Address - Phone:305-743-4000
Mailing Address - Fax:305-743-4459
Practice Address - Street 1:2855 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2239
Practice Address - Country:US
Practice Address - Phone:305-743-4000
Practice Address - Fax:305-743-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH250233336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128410OtherPK
FL003066200Medicaid