Basic Information
| Provider Information | |||||||||
| NPI: | 1982688230 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTH MIAMI HOSPITAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTH MIAMI HOSPITAL | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6855 RED RD | ||||||||
| Address2: | STE 500 | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866627980 | ||||||||
| FaxNumber: | 7865339403 | ||||||||
| Practice Location | |||||||||
| Address1: | 6200 SW 73RD ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866624000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DUQUETTE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7866627111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 4033 | FL | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 673316 | 01 | FL | AETNA HMO | OTHER | 94530 | 01 | FL | AMERIGROUP | OTHER | 1507 | 01 | FL | MEDICA | OTHER | 244 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 438155 | 01 | FL | UNITED HEALTHCARE | OTHER | 010058700 | 05 | FL | MEDICAID | 6201215 | 01 | FL | AETNA NON HMO | OTHER | SMIAMI1000 | 01 | FL | NEIGHBORHOOD HEALTH | OTHER | 101684 | 01 | FL | AVMED | OTHER |