Healthcare Provider Details

I. General information

NPI: 1841647963
Provider Name (Legal Business Name): SKY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 SW 38TH AVE STE 800
MIAMI FL
33146-1530
US

IV. Provider business mailing address

3150 SW 38TH AVE STE 800
MIAMI FL
33146-1530
US

V. Phone/Fax

Practice location:
  • Phone: 786-631-3175
  • Fax: 786-703-6196
Mailing address:
  • Phone: 786-631-3175
  • Fax: 786-703-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberME106104
License Number StateFL

VIII. Authorized Official

Name: DR. JAIME IVAN FLORES
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 786-631-3175