Healthcare Provider Details

I. General information

NPI: 1013942432
Provider Name (Legal Business Name): PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NW 170TH ST
NORTH MIAMI BEACH FL
33169-5521
US

IV. Provider business mailing address

PO BOX 12493
MIAMI FL
33101-2493
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8957
  • Fax: 305-585-5259
Mailing address:
  • Phone: 786-466-8080
  • Fax: 305-355-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number3998
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number3998
License Number State

VIII. Authorized Official

Name: MR. MARK T KNIGHT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 305-585-7979