Provider Demographics
NPI: | 1386654481 |
---|---|
Name: | RCM MEDICAL CENTER INC |
Entity type: | Organization |
Organization Name: | RCM MEDICAL CENTER INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROSELL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GORDILLO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 786-273-6311 |
Mailing Address - Street 1: | 527 EAST 9TH ST |
Mailing Address - Street 2: | SUITE 2 |
Mailing Address - City: | HIALEAH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33010 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-889-0434 |
Mailing Address - Fax: | 305-889-0471 |
Practice Address - Street 1: | 527 EAST 9TH ST |
Practice Address - Street 2: | SUITE 2 |
Practice Address - City: | HIALEAH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33010 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-889-0434 |
Practice Address - Fax: | 305-889-0471 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-09 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
K9854 | Medicare ID - Type Unspecified |