Healthcare Provider Details

I. General information

NPI: 1841708005
Provider Name (Legal Business Name): HOSPITAL INNOVATION PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
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: 386-274-7800
  • Fax: 386-274-7801
Mailing address:
  • Phone: 786-457-4900
  • Fax: 833-548-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RUDDY VALDES
Title or Position: PRESIDENT
Credential: DO
Phone: 954-615-7179