Provider Demographics
NPI:1427270412
Name:PROJECT ACCESS FOUNDATION INC
Entity type:Organization
Organization Name:PROJECT ACCESS FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-759-4778
Mailing Address - Street 1:8000 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4621
Mailing Address - Country:US
Mailing Address - Phone:305-759-4778
Mailing Address - Fax:305-675-5753
Practice Address - Street 1:8000 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4621
Practice Address - Country:US
Practice Address - Phone:305-759-4778
Practice Address - Fax:305-751-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208D00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268908101Medicaid
FLK5396AOtherMEDICARE PTAN