Provider Demographics
NPI:1528257276
Name:DEWHURST MEDICALSERVICES, INC.
Entity type:Organization
Organization Name:DEWHURST MEDICALSERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEWHURST
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-573-3397
Mailing Address - Street 1:1127 MERIDIAN AVE
Mailing Address - Street 2:#7
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4545
Mailing Address - Country:US
Mailing Address - Phone:786-573-3397
Mailing Address - Fax:786-573-2367
Practice Address - Street 1:1127 MERIDIAN AVE
Practice Address - Street 2:#7
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-4545
Practice Address - Country:US
Practice Address - Phone:786-573-3397
Practice Address - Fax:786-573-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3124292363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD406Medicare PIN
FLU3349WMedicare Oscar/Certification