MEDICARE: BUENA VISTA MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician		FL

General Provider Information

NPI Number	:	1205094034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUENA VISTA MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	11300 NW 87TH CT STE 167
Second Line	:	#167
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4521
Country	:	US
Telephone Number	:	305-828-7520
Fax Number	:

Provider Business Practice Location Address
First Line	:	11300 NW 87TH CT STE 167
Second Line	:	#167
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4521
Country	:	US
Telephone Number	:	305-828-7520
Fax Number	:

Authorized Official
Title or Position	:	PDT
Name	:	JERRY A SPIEGEL
Credential	:	MD
Telephone Number	:	305-828-7520

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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