Healthcare Provider Details

I. General information

NPI: 1417321357
Provider Name (Legal Business Name): BAPTIST HEALTH MEDICAL PLAZA COUNTRY WALK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 SW 152ND ST
MIAMI FL
33177-1111
US

IV. Provider business mailing address

13500 SW 152ND ST
MIAMI FL
33177-1111
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-4300
  • Fax:
Mailing address:
  • Phone: 786-596-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP WEIMER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 786-596-7992