Healthcare Provider Details

I. General information

NPI: 1023351913
Provider Name (Legal Business Name): COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 GRAND AVE
MIAMI FL
33133-4862
US

IV. Provider business mailing address

10300 SW 216TH ST
MIAMI FL
33190-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-253-5100
  • Fax: 305-252-5881
Mailing address:
  • Phone: 305-253-5100
  • Fax: 305-252-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BLAKE HALL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-253-5100