Healthcare Provider Details

I. General information

NPI: 1578053070
Provider Name (Legal Business Name): SOUTH MIAMI MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10740 W FLAGLER ST STE 4
MIAMI FL
33174-4405
US

IV. Provider business mailing address

14340 SW 172ND ST
MIAMI FL
33177-2736
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-4871
  • Fax: 305-675-2668
Mailing address:
  • Phone: 305-807-4871
  • Fax: 305-675-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUIS M ROLLE
Title or Position: PRESIDENT
Credential: OWNER
Phone: 305-807-4871