Basic Information
| Provider Information | |||||||||
| NPI: | 1134686967 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN FLORIDA HEALTHCARE SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5927 SW 70TH ST # 439031 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331432707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056662427 | ||||||||
| FaxNumber: | 3056661065 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 BRICKELL KEY DR STE 700 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331312649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059821340 | ||||||||
| FaxNumber: | 3056661065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2019 | ||||||||
| LastUpdateDate: | 02/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCKITTRICK | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | EMMETT | ||||||||
| AuthorizedOfficialTitleorPosition: | MGR | ||||||||
| AuthorizedOfficialTelephone: | 3059821340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | ME127290 | 01 | FL | MEDICAL LICENSE | OTHER |