Provider Demographics
NPI:1306354626
Name:SOUTH FLORIDA CRITICAL CARE SERVICES LLC
Entity type:Organization
Organization Name:SOUTH FLORIDA CRITICAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-281-9398
Mailing Address - Street 1:PO BOX 282070
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33630-2070
Mailing Address - Country:US
Mailing Address - Phone:305-928-7249
Mailing Address - Fax:305-630-3632
Practice Address - Street 1:8370 W FLAGLER ST STE 226
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2040
Practice Address - Country:US
Practice Address - Phone:305-928-7249
Practice Address - Fax:305-630-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024311500Medicaid