=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306249917
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH AND REHAB SERVICES OF SOUTH FLORIDA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2014
-----------------------------------------------------
Last Update Date | 09/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 FOUNTAINBLEAU BLVD SUITE 2G8A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-400-8786
-----------------------------------------------------
Fax | 305-400-8965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 FOUNTAINBLEAU BLVD SUITE 2G8A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-400-8786
-----------------------------------------------------
Fax | 305-400-8965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KEITH GOULDS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-400-8786
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | OS6352
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------