Provider Demographics
NPI:1184931172
Name:SOUTH MIAMI MEDICAL, INC
Entity type:Organization
Organization Name:SOUTH MIAMI MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIOSCORIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-326-4707
Mailing Address - Street 1:2550 NW 72ND AVE
Mailing Address - Street 2:SUTE 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1350
Mailing Address - Country:US
Mailing Address - Phone:305-592-1573
Mailing Address - Fax:305-597-1530
Practice Address - Street 1:2550 NW 72ND AVE
Practice Address - Street 2:SUTE 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1350
Practice Address - Country:US
Practice Address - Phone:305-592-1573
Practice Address - Fax:305-597-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty