MEDICARE: PUBLIC HEALTH TRUST OF MIAMI CONTY FLORIDA

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	261QU0200X	Urgent Care Clinic/Center

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	:	1982146585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HEALTH TRUST OF MIAMI CONTY FLORIDA

Provider Business Mailing Address
First Line	:	PO BOX 12493
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33101-2493
Country	:	US
Telephone Number	:	786-466-8080
Fax Number	:	305-355-2377

Provider Business Practice Location Address
First Line	:	16555 NW 25TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6583
Country	:	US
Telephone Number	:	305-585-8859
Fax Number	:	305-355-5380

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. MARK T KNIGHT
Credential	:
Telephone Number	:	305-585-7979

Provider Enumeration Date	:	11/14/2016
Last Update Date	:	04/06/2017

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Directions to “PUBLIC HEALTH TRUST OF MIAMI CONTY FLORIDA ” Practice Location

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