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NPI Code Detail

MEDICARE: BANYAN COMMUNITY HEALTH CENTER, INC.

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
1251S00000XCommunity/Behavioral Health Agency
2261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

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

General Provider Information

NPI Number : 1205219003
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 : 10720 CARIBBEAN BLVD STE 420
Second Line :
City : CUTLER BAY
State : FL
Zip : 33189-1244
Country : US
Telephone Number : 786-293-9544
Fax Number :
Authorized Official
Title or Position : CEO
Name : MANUEL ANDRES FERNANDEZ
Credential :
Telephone Number : 561-213-9211
Provider Enumeration Date : 06/30/2015
Last Update Date : 04/15/2025

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