Provider Demographics
NPI:1194758748
Name:K & A MEDICAL CENTER INC
Entity type:Organization
Organization Name:K & A MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:H
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-335-5495
Mailing Address - Street 1:3383 NW 7TH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4140
Mailing Address - Country:US
Mailing Address - Phone:305-642-0936
Mailing Address - Fax:305-642-0938
Practice Address - Street 1:3383 NW 7TH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4140
Practice Address - Country:US
Practice Address - Phone:305-642-0936
Practice Address - Fax:305-642-0938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K & A MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5962261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6197Medicare ID - Type UnspecifiedGROUP PROVIDER PART B