Provider Demographics
NPI:1316928534
Name:C & I MEDICAL CENTER CORP
Entity type:Organization
Organization Name:C & I MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KALIE
Authorized Official - Middle Name:KALIEBA
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-824-0880
Mailing Address - Street 1:13903 NW 67TH AVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2939
Mailing Address - Country:US
Mailing Address - Phone:305-824-0880
Mailing Address - Fax:
Practice Address - Street 1:13903 NW 67TH AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33014-2939
Practice Address - Country:US
Practice Address - Phone:305-824-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2397Medicare ID - Type UnspecifiedMEDICARE FL