Provider Demographics
NPI:1063411874
Name:MIAMI BEACH COMMUNITY HEALTH CENTER INC
Entity type:Organization
Organization Name:MIAMI BEACH COMMUNITY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR EXECUTIVE VP OF HR
Authorized Official - Prefix:
Authorized Official - First Name:LIZEL
Authorized Official - Middle Name:VIONET
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:305-583-4749
Mailing Address - Street 1:11645 BISCAYNE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3138
Mailing Address - Country:US
Mailing Address - Phone:305-538-8835
Mailing Address - Fax:305-938-4044
Practice Address - Street 1:710 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-5504
Practice Address - Country:US
Practice Address - Phone:305-538-8835
Practice Address - Fax:305-532-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X, 251S00000X
FL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029544200Medicaid
FL029544226Medicaid
FL037485700Medicaid
FL029544210Medicaid
FL029544201Medicaid
FL029544207Medicaid
FL029544200Medicaid
FL105384100Medicaid
FL29234600Medicaid
FL029544209Medicaid
FL037485700Medicaid
FL029544210Medicaid
FL077846000Medicaid