Healthcare Provider Details

I. General information

NPI: 1316817851
Provider Name (Legal Business Name): HOSPITAL MINIMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ED TIMES SQ 8 BELLA VISAT
PANAMA CITY PANAMA
87877
PA

IV. Provider business mailing address

6614 AVENUE U # 90743
BROOKLYN NY
11234-6021
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. JAVIER EZQUERRA
Title or Position: MANAGER
Credential: MD
Phone: 801-896-1181