Healthcare Provider Details

I. General information

NPI: 1477871069
Provider Name (Legal Business Name): JACKSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 E WHITEWATER AVE
WESTON FL
33332-2409
US

IV. Provider business mailing address

4304 E WHITEWATER AVE
WESTON FL
33332-2409
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5271
  • Fax:
Mailing address:
  • Phone: 305-585-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: PROF. TOMAS SALERNO
Title or Position: CHIEF OF THORACIC SURGERY
Credential: M.D.
Phone: 305-585-5271