Healthcare Provider Details

I. General information

NPI: 1952767402
Provider Name (Legal Business Name): JESSIE TRICE COMMUNITY HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 36TH ST
MIAMI FL
33142-5558
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: 305-805-1715
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: ANNIE R NEASMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-805-1700