Basic Information
| Provider Information | |||||||||
| NPI: | 1811135577 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTH DADE URGENT CARE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 7540 S.W. 61 AVENUE | ||||||||
| Address2: | SOUTH DADE URGENT CARE CENTER | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331435012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056665052 | ||||||||
| FaxNumber: | 3056610905 | ||||||||
| Practice Location | |||||||||
| Address1: | 7540 S.W. 61 AVENUE | ||||||||
| Address2: | SOUTH DADE URGENT CARE CENTER | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331435012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056665052 | ||||||||
| FaxNumber: | 3056610905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2009 | ||||||||
| LastUpdateDate: | 02/03/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SERRANO | ||||||||
| AuthorizedOfficialFirstName: | MARGIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3056665052 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OFFICE MANAGER | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | ME0027176 | FL | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QU0200X | ME0092409 | FL | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QU0200X | ME0016658 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.