MEDICARE: ATHENNAS MEDICAL 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	174400000X	Specialist

General Provider Information

NPI Number	:	1346294949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHENNAS MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	633 NE 167TH ST
Second Line	:	SUITE 1111
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2442
Country	:	US
Telephone Number	:	305-493-4659
Fax Number	:	305-493-4660

Provider Business Practice Location Address
First Line	:	633 NE 167TH ST
Second Line	:	SUITE 1111
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2442
Country	:	US
Telephone Number	:	305-493-4659
Fax Number	:	305-493-4660

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DAHIMY AVILA
Credential	:
Telephone Number	:	305-493-4659

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/22/2020

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