Healthcare Provider Details

I. General information

NPI: 1881021954
Provider Name (Legal Business Name): USPHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18201 SW 12TH ST
MIAMI FL
33194-2700
US

IV. Provider business mailing address

18201 SW 12TH ST
MIAMI FL
33194-2700
US

V. Phone/Fax

Practice location:
  • Phone: 305-207-5086
  • Fax:
Mailing address:
  • Phone: 305-207-5086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License NumberPA9107559
License Number StateFL

VIII. Authorized Official

Name: MRS. EUNICE JONES-WILLS
Title or Position: HOSPITAL ADMINISTRATION
Credential:
Phone: 305-207-2121