MEDICARE: SERVICE MEDICAL REHABILITATION

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	261QC1500X	Community Health Clinic/Center	600195-2	FL

General Provider Information

NPI Number	:	1780636878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVICE MEDICAL REHABILITATION

Provider Business Mailing Address
First Line	:	3750 W 16TH AVE
Second Line	:	SUITE 140 U
City	:	HIALEAH
State	:	FL
Zip	:	33012-4654
Country	:	US
Telephone Number	:	305-826-5567
Fax Number	:	305-826-5568

Provider Business Practice Location Address
First Line	:	3750 W 16TH AVE
Second Line	:	SUITE 140 U
City	:	HIALEAH
State	:	FL
Zip	:	33012-4654
Country	:	US
Telephone Number	:	305-826-5567
Fax Number	:	305-826-5568

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JUAN A NIEVES SR.
Credential	:
Telephone Number	:	305-826-5567

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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Directions to “SERVICE MEDICAL REHABILITATION ” Practice Location

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