=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114368396
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE SPECIALTY DOCTORS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2013
-----------------------------------------------------
Last Update Date | 07/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6800 SW 40TH ST # 238
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-281-5484
-----------------------------------------------------
Fax | 786-364-0185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6800 SW 40TH ST # 238
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-281-5484
-----------------------------------------------------
Fax | 786-364-0185
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, OPERATIONS
-----------------------------------------------------
Name | ROBERT SCHNEIDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-215-0090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------