MEDICARE: CAMILLUS HEALTH CONCERN, 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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659536365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMILLUS HEALTH CONCERN, INC.

Provider Business Mailing Address
First Line	:	336 NW 5TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33128-1616
Country	:	US
Telephone Number	:	305-577-4840
Fax Number	:	305-373-7431

Provider Business Practice Location Address
First Line	:	1907 NW 38TH ST STE 195
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-5446
Country	:	US
Telephone Number	:	305-637-6720
Fax Number	:	305-635-1123

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	FRANCIS AFRAM-GYENING
Credential	:	FACHE
Telephone Number	:	305-533-0189

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	02/11/2021

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