MEDICARE: SOUTH MIAMI HOSPITAL 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	282N00000X	General Acute Care Hospital	4033	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	673316	OTHER	FL	AETNA HMO
2	94530	OTHER	FL	AMERIGROUP
3	1507	OTHER	FL	MEDICA
4	244	OTHER	FL	BLUE CROSS BLUE SHIELD
5	438155	OTHER	FL	UNITED HEALTHCARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	6201215	OTHER	FL	AETNA NON HMO
8	SMIAMI1000	OTHER	FL	NEIGHBORHOOD HEALTH
9	101684	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1982688230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MIAMI HOSPITAL INC

Provider Business Mailing Address
First Line	:	6855 RED RD
Second Line	:	STE 500
City	:	CORAL GABLES
State	:	FL
Zip	:	33143-3623
Country	:	US
Telephone Number	:	786-662-7980
Fax Number	:	786-533-9403

Provider Business Practice Location Address
First Line	:	6200 SW 73RD ST
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4679
Country	:	US
Telephone Number	:	786-662-4000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	WILLIAM DUQUETTE
Credential	:
Telephone Number	:	786-662-7111

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	02/24/2022

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