Healthcare Provider Details

I. General information

NPI: 1043334162
Provider Name (Legal Business Name): JACKSON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 SW 72ND AVENUE
MIAMI FL
33156
US

IV. Provider business mailing address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-6798
  • Fax:
Mailing address:
  • Phone: 305-585-6262
  • Fax: 305-585-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberME9057
License Number StateFL

VIII. Authorized Official

Name: AUGUSTO SARMIENTO
Title or Position: ASSOC MEDICAL DIRECTOR
Credential: MD
Phone: 305-585-6262