Healthcare Provider Details

I. General information

NPI: 1548037807
Provider Name (Legal Business Name): SUNSOUTH ST. JUDE HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8374 PINES BLVD
PEMBROKE PINES FL
33024-6616
US

IV. Provider business mailing address

14690 SPRING HILL DR
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 954-429-6986
  • Fax: 954-429-6987
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS ARIAS
Title or Position: CEO
Credential:
Phone: 352-277-5305