Provider Demographics
NPI:1306090105
Name:SOUTHERN ADVANCES INC
Entity type:Organization
Organization Name:SOUTHERN ADVANCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IHOSVANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-879-2369
Mailing Address - Street 1:13876 SW 56TH ST
Mailing Address - Street 2:SUITE 272
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6021
Mailing Address - Country:US
Mailing Address - Phone:305-879-2369
Mailing Address - Fax:305-675-8334
Practice Address - Street 1:13876 SW 56TH ST
Practice Address - Street 2:SUITE 272
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6021
Practice Address - Country:US
Practice Address - Phone:305-879-2369
Practice Address - Fax:305-675-8334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service