Organization
SOUTHGATE MEDICAL OF FLORIDA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD EUGENE STACEY SR. LNHA (VICE-PRESIDENT)
(305) 926-0960
Entity
Organization
Contact information
Practice address
899 NW 4TH ST, MIAMI, FL 33128-1309
(305) 926-0960
(305) 326-1647
Mailing address
899 NW 4TH ST, MIAMI, FL 33128-1309
(305) 926-0960
(305) 326-1647
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
976
FL
Other
Enumeration date
01/25/2007
Last updated
08/22/2020
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