Basic Information
| Provider Information | |||||||||
| NPI: | 1093871568 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SHORE EKG ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5927 SW 70TH ST # 439031 | ||||||||
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| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056654614 | ||||||||
| FaxNumber: | 3056670239 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 NW 95TH ST | ||||||||
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| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331502038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056654614 | ||||||||
| FaxNumber: | 3056670239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 10/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | CENTURION | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3056654614 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 379174200 | 05 | FL | MEDICAID |