Provider Demographics
NPI:1154611036
Name:SAVICO MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:SAVICO MEDICAL ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COMFORT
Authorized Official - Middle Name:OMOBOLA
Authorized Official - Last Name:ADEWUMI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-757-4442
Mailing Address - Street 1:17439 NW 66TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4431
Mailing Address - Country:US
Mailing Address - Phone:305-974-5750
Mailing Address - Fax:305-757-4443
Practice Address - Street 1:18356 NW 47TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2934
Practice Address - Country:US
Practice Address - Phone:305-974-5750
Practice Address - Fax:305-757-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8579261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275310300Medicaid
FL275310300Medicaid