MEDICARE: JESSIE TRICE COMMUNITY HEALTH SYSTEM 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)

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

General Provider Information

NPI Number	:	1467614099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSIE TRICE COMMUNITY HEALTH SYSTEM INC

Provider Business Mailing Address
First Line	:	5607 NW 27TH AVE
Second Line	:	STE 1
City	:	MIAMI
State	:	FL
Zip	:	33142-2826
Country	:	US
Telephone Number	:	305-805-1700
Fax Number	:	305-805-1715

Provider Business Practice Location Address
First Line	:	1190 NW 95TH ST STE 304
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33150-2066
Country	:	US
Telephone Number	:	305-637-6400
Fax Number	:	305-636-5155

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	RYAN R HAWKINS
Credential	:
Telephone Number	:	305-805-1700

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	11/26/2024

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