Healthcare Provider Details

I. General information

NPI: 1801966676
Provider Name (Legal Business Name): PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28205 SW 125TH AVE
HOMESTEAD FL
33033-1250
US

IV. Provider business mailing address

PO BOX 12493
MIAMI FL
33101-2493
US

V. Phone/Fax

Practice location:
  • Phone: 305-416-7149
  • Fax: 305-585-5259
Mailing address:
  • Phone: 786-466-8080
  • Fax: 305-355-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK T KNIGHT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 305-585-7979