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NPI Code Detail

MEDICARE: OCEAN STAR PROFESSIONAL MEDICAL CENTER INC

MEDICARE: OCEAN STAR PROFESSIONAL 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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HCC5841OTHERFLAHCA LICENSE

General Provider Information

NPI Number : 1992750327
Entity Type Code : Organization
Provider Name (Legal Business Name) : OCEAN STAR PROFESSIONAL MEDICAL CENTER INC
Provider Business Mailing Address
First Line : 2623 SW 147TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33185-5622
Country : US
Telephone Number : 305-553-5155
Fax Number : 305-553-5156
Provider Business Practice Location Address
First Line : 2623 SW 147TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33185-5622
Country : US
Telephone Number : 305-553-5155
Fax Number : 305-553-5156
Authorized Official
Title or Position : PRESIDENT
Name : CARLOS EDDY CARMENATE
Credential :
Telephone Number : 305-553-5155
Provider Enumeration Date : 05/24/2006
Last Update Date : 08/22/2020

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Directions to “OCEAN STAR PROFESSIONAL MEDICAL CENTER INC ” Practice Location

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