MEDICARE: PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA

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	261QM2500X	Medical Specialty Clinic/Center

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

General Provider Information

NPI Number	:	1831263771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA

Provider Business Mailing Address
First Line	:	1951 NW 7TH AVE
Second Line	:	SUITE 160, BOX 140
City	:	MIAMI
State	:	FL
Zip	:	33136-1104
Country	:	US
Telephone Number	:	305-355-5222
Fax Number	:	305-355-5380

Provider Business Practice Location Address
First Line	:	1477 NW 8TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1425
Country	:	US
Telephone Number	:	305-585-8957
Fax Number	:	305-585-5259

Authorized Official
Title or Position	:	EXECUTIVE VP, CFO
Name	:	MR. MARK T KNIGHT
Credential	:
Telephone Number	:	305-585-8490

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	04/21/2014

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