Organization
WHEAT LLC
Active
Other names
Cooper Medical Management, WHEAT L L C
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA F COOPER (DIRECTOR)
(954) 661-7227
Entity
Organization
Contact information
Practice address
2627 NE 203RD ST STE 109, MIAMI, FL 33180-1945
(305) 528-2836
(305) 682-8994
Mailing address
2627 NE 203RD ST STE 109, MIAMI, FL 33180-1945
(305) 682-8700
(305) 682-8994
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D2181154
CLIA
FL
01
—
10D2181356
CLIA
FL
01
—
13-64-202-7797
BIOMEDICAL WASTE CLINICAL LABORATORY
FL
01
—
6011757
HEALTH CARE CLINIC ESTABLSHMENT
FL
01
—
E063187
INSURANCE 2-15
FL
Enumeration date
05/21/2020
Last updated
04/23/2026
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