=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447298658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTCHESTER SURGICAL CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8364 SW 8TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-4180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-262-3262
-----------------------------------------------------
Fax | 305-262-3242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13985 SW 20TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-7002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-244-2546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ISMAEL LABRADOR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-262-3260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | ME92214
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------