MEDICARE: MIAMI COMMUNITY HEALTH 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

General Provider Information

NPI Number	:	1376127621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	891-893 EAST 10TH AVENUE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010
Country	:	US
Telephone Number	:	305-381-5150
Fax Number	:	305-851-0335

Provider Business Practice Location Address
First Line	:	3523 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7266
Country	:	US
Telephone Number	:	239-541-8442
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DIANA TORRES
Credential	:
Telephone Number	:	305-381-5150

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	05/11/2021

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