Provider Demographics
NPI:1285611913
Name:QUALMED OF SOUTH DADE, INC.
Entity type:Organization
Organization Name:QUALMED OF SOUTH DADE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:PALACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-398-0807
Mailing Address - Street 1:26085 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:NARANJA
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6613
Mailing Address - Country:US
Mailing Address - Phone:305-246-2221
Mailing Address - Fax:305-269-8825
Practice Address - Street 1:27535 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NARANJA
Practice Address - State:FL
Practice Address - Zip Code:33032-8225
Practice Address - Country:US
Practice Address - Phone:305-246-2221
Practice Address - Fax:305-269-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272061200Medicaid
FL063744100Medicaid
FL260520100Medicaid
FLF70213Medicare UPIN
FL260520100Medicaid
FLE27833Medicare UPIN