Basic Information
| Provider Information | |||||||||
| NPI: | 1588737191 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JACKSON MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6330 PENT PL | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330142306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053354275 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1611 NW 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055856586 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | GROSS-RAMOS | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
| AuthorizedOfficialMiddleName: | PAOLA | ||||||||
| AuthorizedOfficialTitleorPosition: | C.R.N.A | ||||||||
| AuthorizedOfficialTelephone: | 3055856586 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | C.R.N.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 2053812 | FL | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.