MEDICARE: SOUTH MIAMI HOSPITAL, 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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1497201552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MIAMI HOSPITAL, INC

Provider Business Mailing Address
First Line	:	6501 CITY WEST PKWY
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3248
Country	:	US
Telephone Number	:	952-653-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	14701 NW 77TH AVE
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2500
Country	:	US
Telephone Number	:	786-662-0700
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. PHILIP WEIMER
Credential	:	M.D.
Telephone Number	:	786-596-7992

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	08/29/2016

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