=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578690236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 04/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 NW 170TH ST
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-5521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-585-8957
-----------------------------------------------------
Fax | 305-585-5259
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 12493
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33101-2493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-466-8101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXEC.VP, CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MR. MARK T KNIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-585-7137
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PE0004X
-----------------------------------------------------
Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
-----------------------------------------------------
License Number | 3998
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------