Provider Demographics
NPI:1427470418
Name:MIAMI INTERNATIONAL MEDICAL CENTER LLC
Entity type:Organization
Organization Name:MIAMI INTERNATIONAL MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-267-8662
Mailing Address - Street 1:5959 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3129
Mailing Address - Country:US
Mailing Address - Phone:305-267-8662
Mailing Address - Fax:786-513-0499
Practice Address - Street 1:5959 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3129
Practice Address - Country:US
Practice Address - Phone:305-267-8662
Practice Address - Fax:786-513-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100328Medicare PIN
FL100328Medicare Oscar/Certification