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General NPI Number Information
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NPI Number | 1861603706
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Entity Type | Organization
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Legal Business Name | JACKSON MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1600 NW 12TH AVE. SUITE C-150
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City | MIAMI
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State | FL
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Zip | 33136
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Country | US
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Telephone | 305-585-1520
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Fax | 305-585-1551
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Provider Business Mailing Address
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Address Line | 7634 S.W. 106 AVE.
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City | MIAMI
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State | FL
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Zip | 33173
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Country | US
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Telephone | 305-742-5717
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Fax |
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Authorized Official
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Title or Position | MD- DEPARTMENT OF UROLOGY
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Name | DR. CHARLES LYNNE
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Credential | MD
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Telephone | 305-585-1520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 1646212
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1646212
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License Number State | FL
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