MEDICARE: BANYAN 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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

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

General Provider Information

NPI Number	:	1538576459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANYAN COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	6100 BLUE LAGOON DR
Second Line	:	SUITE 400
City	:	MIAMI
State	:	FL
Zip	:	33126-2079
Country	:	US
Telephone Number	:	305-398-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1566 SW 1ST ST
Second Line	:	SUITE 21-23
City	:	MIAMI
State	:	FL
Zip	:	33135-2103
Country	:	US
Telephone Number	:	305-642-8325
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VINCENT CARRODEGUAS
Credential	:
Telephone Number	:	305-398-6100

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/28/2021

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