MEDICARE: HEALING LANDS 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	261Q00000X	Clinic/Center	HCC8998	FL

General Provider Information

NPI Number	:	1588961957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING LANDS MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	6157 NW 167TH ST
Second Line	:	SUITE F-13
City	:	HIALEAH
State	:	FL
Zip	:	33015-4337
Country	:	US
Telephone Number	:	305-828-7522
Fax Number	:	305-828-7524

Provider Business Practice Location Address
First Line	:	6157 NW 167TH ST
Second Line	:	SUITE F-13
City	:	HIALEAH
State	:	FL
Zip	:	33015-4337
Country	:	US
Telephone Number	:	305-828-7522
Fax Number	:	305-828-7524

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIRTHA FERNANDEZ
Credential	:
Telephone Number	:	305-828-7522

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	04/30/2012

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