MEDICARE: PASTEUR 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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1609188580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASTEUR MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	4578 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3325
Country	:	US
Telephone Number	:	305-827-9687
Fax Number	:	305-398-1474

Provider Business Practice Location Address
First Line	:	4554 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3325
Country	:	US
Telephone Number	:	305-827-9687
Fax Number	:	305-398-1474

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MR. TARIK HAWATMEH
Credential	:
Telephone Number	:	786-422-6821

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	02/21/2017

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