Basic Information
| Provider Information | |||||||||
| NPI: | 1780757625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTH OF SOUTH DADE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14139 SW 146TH TER | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331867206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052346526 | ||||||||
| FaxNumber: | 3052451161 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 W MOWRY DR | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330305746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052426040 | ||||||||
| FaxNumber: | 3052451161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AMOFAH | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3052426040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | ME84978 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.