=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821548058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LARKIN COMMUNITY HOSPITAL PALM SPRINGS CAMPUS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2016
-----------------------------------------------------
Last Update Date | 10/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1475 W 49TH PL
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-558-2500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1475 W 49TH PL
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-558-2500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | IRIS BERGES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-558-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------