Provider Demographics
NPI:1306870571
Name:JOHNSON MEDICAL CENTER CORP
Entity type:Organization
Organization Name:JOHNSON MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:URBINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-962-5300
Mailing Address - Street 1:6517 TAFT ST
Mailing Address - Street 2:#100
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4050
Mailing Address - Country:US
Mailing Address - Phone:954-962-5300
Mailing Address - Fax:954-962-0100
Practice Address - Street 1:6517 TAFT ST
Practice Address - Street 2:#100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4050
Practice Address - Country:US
Practice Address - Phone:954-962-5300
Practice Address - Fax:954-962-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40681Medicare ID - Type UnspecifiedMEDICARE