MEDICARE: COMMUNITY HEALTH OF SOUTH FLORIDA 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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1306211719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH OF SOUTH FLORIDA INC

Provider Business Mailing Address
First Line	:	10300 SW 216TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33190-1003
Country	:	US
Telephone Number	:	305-253-5100
Fax Number	:	305-254-4987

Provider Business Practice Location Address
First Line	:	4861 SW 140TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-4807
Country	:	US
Telephone Number	:	305-221-0461
Fax Number	:	305-552-1270

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	BRODES H HARTLEY JR.
Credential	:
Telephone Number	:	305-253-5100

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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