Healthcare Provider Details

I. General information

NPI: 1649194911
Provider Name (Legal Business Name): JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9536 NE 2ND AVE
MIAMI SHORES FL
33138-2705
US

IV. Provider business mailing address

5607 NW 27TH AVE STE 1
MIAMI FL
33142-2826
US

V. Phone/Fax

Practice location:
  • Phone: 305-637-6400
  • Fax: 305-636-5155
Mailing address:
  • Phone: 305-637-6400
  • Fax: 305-835-1598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RYAN HAWKINS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-805-1700