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)

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508010323
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	:	MIAMI
State	:	FL
Zip	:	33190-1003
Country	:	US
Telephone Number	:	305-253-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 SW 147TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-3916
Country	:	US
Telephone Number	:	305-552-6205
Fax Number	:

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

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	09/19/2013

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