Provider Demographics
NPI:1699967406
Name:SPECIALTY MEDICAL INC
Entity type:Organization
Organization Name:SPECIALTY MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-698-1895
Mailing Address - Street 1:3750 W 16TH AVE
Mailing Address - Street 2:SUITE 238 U
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4654
Mailing Address - Country:US
Mailing Address - Phone:305-698-1895
Mailing Address - Fax:305-698-1897
Practice Address - Street 1:3750 W 16TH AVE
Practice Address - Street 2:SUITE 238 U
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4654
Practice Address - Country:US
Practice Address - Phone:305-698-1895
Practice Address - Fax:305-698-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686783Medicare PIN