Healthcare Provider Details

I. General information

NPI: 1184040560
Provider Name (Legal Business Name): SMALL HOSPITAL INNOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W SAGAMORE AVE
CLEWISTON FL
33440-3514
US

IV. Provider business mailing address

PO BOX 277615
MIRAMAR FL
33027-7615
US

V. Phone/Fax

Practice location:
  • Phone: 954-615-7179
  • Fax:
Mailing address:
  • Phone: 786-457-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS7985
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS7985
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RUDDY VALDES
Title or Position: PRESIDENT
Credential: D.O.
Phone: 786-457-4900