Basic Information
| Provider Information | |||||||||
| NPI: | 1376579839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEON MEDICAL CENTERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8600 NW 41ST ST | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331666202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056425366 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11501 SW 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331653313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056425366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEON | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 3056425366 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
ID Information
| ID | Type | State | Issuer | Description | 40907A | 01 | FL | MEDICARE PTAN | OTHER |