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NPI Code Detail

MEDICARE: MIR LAND EUGENE MA, MS

MEDICARE: MIR LAND EUGENE MA, MS
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
1101Y00000XCounselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417991555
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIR LAND EUGENE MA, MS
Provider Business Mailing Address
First Line : 11031 NE 6TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33161-7182
Country : US
Telephone Number : 305-398-6100
Fax Number : 305-757-4465
Provider Business Practice Location Address
First Line : 4469 NW 167TH ST
Second Line :
City : OPA LOCKA
State : FL
Zip : 33055-4311
Country : US
Telephone Number : 305-621-1455
Fax Number : 305-621-5508
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 03/25/2024

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Directions to “ MIR LAND EUGENE MA, MS” Practice Location

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