=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467826396
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAPTIST HEALTH URGENT CARE KENDALE LAKES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2015
-----------------------------------------------------
Last Update Date | 11/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14661 SW 56TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-5703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-467-5260
-----------------------------------------------------
Fax | 786-533-9963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14661 SW 56TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-5703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-467-5260
-----------------------------------------------------
Fax | 786-533-9963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. PHILIP WEIMER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 786-596-7992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------