Healthcare Provider Details

I. General information

NPI: 1821498999
Provider Name (Legal Business Name): JESSIE TRICE COMMUNITY HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 NW 75TH ST
MIAMI FL
33147-6025
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 305-637-6400
  • Fax: 305-636-5155
Mailing address:
  • Phone: 305-805-1700
  • Fax: 305-805-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RYAN R HAWKINS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-805-1700