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NPI Code Detail

MEDICARE: HELEN B BENTLEY FAMILY HEALTH CENTER

MEDICARE: HELEN B BENTLEY FAMILY HEALTH CENTER
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
1261QF0400XFederally Qualified Health Center (FQHC)719670FL

Other Identifiers

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

General Provider Information

NPI Number : 1487657516
Entity Type Code : Organization
Provider Name (Legal Business Name) : HELEN B BENTLEY FAMILY HEALTH CENTER
Provider Business Mailing Address
First Line : 3090 SW 37TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33133-4311
Country : US
Telephone Number : 305-447-4950
Fax Number : 305-444-7866
Provider Business Practice Location Address
First Line : 3090 SW 37TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33133-4311
Country : US
Telephone Number : 305-447-4950
Fax Number : 305-444-7866
Authorized Official
Title or Position : PRESIDENT CEO
Name : DR. CALEB A DAVIS
Credential : PHD
Telephone Number : 305-351-1314
Provider Enumeration Date : 05/23/2005
Last Update Date : 08/22/2020

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1982706347 — HELEN B. BENTLEY FAMILY HEALTH CENTER
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