MEDICARE: BANYAN COMMUNITY HEALTH CENTER, 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	251S00000X	Community/Behavioral Health Agency
2	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104247188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANYAN COMMUNITY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	2300 NW 89TH PL FL 3
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33172-2431
Country	:	US
Telephone Number	:	305-398-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3733 W FLAGLER ST
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-1601
Country	:	US
Telephone Number	:	305-398-6100
Fax Number	:	305-398-6099

Authorized Official
Title or Position	:	CEO
Name	:	MANUEL ANDRES FERNANDEZ
Credential	:
Telephone Number	:	561-213-9211

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	04/15/2025

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