Healthcare Provider Details

I. General information

NPI: 1144890013
Provider Name (Legal Business Name): COMMUNITY HEALTH OF SOUTH FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 FORT ST
KEY WEST FL
33040-7307
US

IV. Provider business mailing address

10300 SW 216 ST
MIAMI FL
33190
US

V. Phone/Fax

Practice location:
  • Phone: 305-253-5100
  • Fax:
Mailing address:
  • Phone: 305-278-6434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALLISON MADDEN
Title or Position: AVP, PI
Credential:
Phone: 305-278-6434