=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568894913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DADE MEDICAL SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2013
-----------------------------------------------------
Last Update Date | 09/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2550 NW 72ND AVE SUITE 309
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-477-7498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2550 NW 72ND AVE SUITE 309
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-477-7498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. PATRICIA MARIN
-----------------------------------------------------
Credential | O.T
-----------------------------------------------------
Telephone | 305-477-7498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------