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General NPI Number Information
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NPI Number | 1669636791
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Entity Type | Organization
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Legal Business Name | SOUTH MIAMI CHILDRENS CLINIC INC
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 6701 SW 58TH PL
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City | SOUTH MIAMI
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State | FL
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Zip | 33143
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Country | US
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Telephone | 305-662-5988
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Fax | 305-662-5589
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Provider Business Mailing Address
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Address Line | 6701 SW 58TH PL
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City | SOUTH MIAMI
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State | FL
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Zip | 33143
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Country | US
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Telephone | 305-662-5988
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Fax | 305-662-5589
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | TINA SIMONE CARROLL SCOTT
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Credential | MD
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Telephone | 305-662-5988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME67630
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License Number State | FL
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