Provider Demographics
NPI:1871168880
Name:PEDIATRIC RESPIRATORY CARE OF SOUTH FLORIDA, INC.
Entity type:Organization
Organization Name:PEDIATRIC RESPIRATORY CARE OF SOUTH FLORIDA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALBA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CDME, ACHE
Authorized Official - Phone:305-248-1003
Mailing Address - Street 1:28848 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2405
Mailing Address - Country:US
Mailing Address - Phone:305-248-1003
Mailing Address - Fax:305-248-1009
Practice Address - Street 1:4101 SW 73RD AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2405
Practice Address - Country:US
Practice Address - Phone:305-248-1003
Practice Address - Fax:305-248-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013542900Medicaid