Provider Demographics
NPI:1063624799
Name:CARRION UROLOGICAL CENTER, INC
Entity type:Organization
Organization Name:CARRION UROLOGICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERNAN
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:CARRION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-547-2534
Mailing Address - Street 1:1321 NW 14TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1673
Mailing Address - Country:US
Mailing Address - Phone:305-547-2534
Mailing Address - Fax:305-326-7210
Practice Address - Street 1:1321 NW 14TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1673
Practice Address - Country:US
Practice Address - Phone:305-547-2534
Practice Address - Fax:305-326-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2013-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20544174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053422600Medicaid
FL5417510001Medicare NSC
FLK5290Medicare PIN
FLD79872Medicare UPIN