Provider Demographics
NPI:1316817851
Name:HOSPITAL MINIMED
Entity type:Organization
Organization Name:HOSPITAL MINIMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:EZQUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-896-1181
Mailing Address - Street 1:6614 AVENUE U # 90743
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ED TIMES SQ 8
Practice Address - Street 2:BELLA VISAT
Practice Address - City:PANAMA CITY
Practice Address - State:PANAMA
Practice Address - Zip Code:87877
Practice Address - Country:PA
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access