MEDICARE: VISANT 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
2	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	:	1548740467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISANT MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	1338 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-3904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-3904
Country	:	US
Telephone Number	:	305-323-6410
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VLADIMIR SANTOS
Credential	:
Telephone Number	:	305-323-6410

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	12/19/2022

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Directions to “VISANT MEDICAL CENTER INC ” Practice Location

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