Organization
EBENEZER MEDICAL CENTER LLC
Active
Other names
EBENEZERMED
Organization subpart
No
Provider details
NPI number
Authorized official
RENE ELADIO DISOTUAR ABAD MD (PRESIDENT)
(305) 330-5393
Entity
Organization
Contact information
Practice address
646 W PALM DR, HOMESTEAD, FL 33034-3208
(305) 330-5393
(305) 773-0220
Mailing address
646 W PALM DR, HOMESTEAD, FL 33034-3208
(305) 330-5393
(305) 773-0220
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010733300
—
FL
Enumeration date
07/18/2017
Last updated
07/21/2022
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