Healthcare Provider Details

I. General information

NPI: 1568842615
Provider Name (Legal Business Name): JESSIE TRICE COMMUNITY HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 305-805-1700
  • Fax: 305-805-1715
Mailing address:
  • Phone: 305-805-1700
  • Fax: 305-805-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN12903
License Number StateFL

VIII. Authorized Official

Name: MRS. ANNIE NEASMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-805-1700