MEDICARE: PRESTIGE MEDICAL SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	HCC9068	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FC741A	OTHER	FL	MEDICARE PROVIDER

General Provider Information

NPI Number	:	1013216597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE MEDICAL SERVICES INC

Provider Business Mailing Address
First Line	:	12905 SW 42ND ST STE 101
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2910
Country	:	US
Telephone Number	:	305-553-5600
Fax Number	:	305-553-5602

Provider Business Practice Location Address
First Line	:	12905 SW 42ND ST STE 101
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2910
Country	:	US
Telephone Number	:	305-553-5600
Fax Number	:	305-553-5602

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HUMBERTO HERNANDEZ
Credential	:
Telephone Number	:	305-553-5600

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	08/16/2012

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Directions to “PRESTIGE MEDICAL SERVICES INC ” Practice Location

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