Provider Demographics
NPI:1699889493
Name:RICHARD L. DOLSEY, PHC, INC.
Entity type:Organization
Organization Name:RICHARD L. DOLSEY, PHC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-888-7555
Mailing Address - Street 1:4483 NW 36TH STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:305-888-7555
Mailing Address - Fax:305-888-7404
Practice Address - Street 1:6221 NW 36 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:305-871-3627
Practice Address - Fax:305-871-7569
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD L. DOLSEY, PHC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-18
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
FLOS6525261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91992AMedicare ID - Type Unspecified