=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497096861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOSTRUM MEDICAL CENTER US-1 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2013
-----------------------------------------------------
Last Update Date | 03/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27531 S DIXIE HWY
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-8225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-210-1499
-----------------------------------------------------
Fax | 888-266-9406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27531 S DIXIE HWY
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-8225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-210-1499
-----------------------------------------------------
Fax | 888-266-9406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | JOSE F CHAPMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-210-1499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------