Provider Demographics
NPI:1386700912
Name:NEW LIFE POLYCLINICS INC
Entity type:Organization
Organization Name:NEW LIFE POLYCLINICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:COLUMBIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-884-8880
Mailing Address - Street 1:61 HOOK SQ
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4401
Mailing Address - Country:US
Mailing Address - Phone:305-884-8880
Mailing Address - Fax:305-884-7740
Practice Address - Street 1:61 HOOK SQ
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-4401
Practice Address - Country:US
Practice Address - Phone:305-884-8880
Practice Address - Fax:305-884-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7720208D00000X
305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277418600Medicaid
FL277418600Medicaid