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General NPI Number Information
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NPI Number | 1205233772
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Entity Type | Organization
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Legal Business Name | BANYAN COMMUNITY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 3800 W FLAGLER ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-1604
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Country | US
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Telephone | 305-774-3400
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Fax | 305-442-0482
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Provider Business Mailing Address
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Address Line | 2300 NW 89TH PL FL 3
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City | DORAL
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State | FL
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Zip | 33172-2431
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Country | US
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Telephone | 305-398-6100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MANUEL ANDRES FERNANDEZ
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Credential |
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Telephone | 561-213-9211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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