Provider Demographics
NPI:1699083063
Name:TRI PRO ACTIVE MEDICAL CENTER INC
Entity type:Organization
Organization Name:TRI PRO ACTIVE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:786-573-4777
Mailing Address - Street 1:14471 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7924
Mailing Address - Country:US
Mailing Address - Phone:786-573-4777
Mailing Address - Fax:786-573-4887
Practice Address - Street 1:14471 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7924
Practice Address - Country:US
Practice Address - Phone:786-573-4777
Practice Address - Fax:786-573-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN