Organization
LEGION PARK MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA A ELIZEE (OFFICE ADMINISTRATOR)
(305) 754-8966
Entity
Organization
Contact information
Practice address
6630 BISCAYNE BLVD, MIAMI, FL 33138-6217
(305) 754-8966
Mailing address
6630 BISCAYNE BLVD, MIAMI, FL 33138-6217
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
HCC6998
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K6954
MEDICARE PROVIDER #
FL
Enumeration date
08/27/2007
Last updated
08/27/2007
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